○ Beneficence: APTA Code, Principle 4C (“Physical therapists shall discourage misconduct by health care professionals and report illegal or unethical acts to the relevant authority, when appropriate”). ○ Fidelity: APTA Code, Principle 5D (“Physical therapists shall encourage colleagues with physical, psychological, or substance-related impairments that may adversely impact their professional responsibilities to seek treatment”). ○ Teleological/consequential theory can be applied to this case as well. For example, if Leslie’s coworker has a substance-related impairment, her impairment could result in harm to her clients. On the other hand, if Leslie reports her coworker on suspicion of a substance-related impairment when none exists, her coworker’s professional reputation could be harmed. ● Ethics of care: This is applicable if Leslie considers how her moral action would affect her relationship with her coworker (it is the moral significance of Leslie’s relationship with her coworker that highlights her action). ● Practical alternative: On the basis of an ethics of care, Leslie can approach her coworker about her suspicion and encourage her coworker to seek help. However, if the coworker continues to come to work under the influence, Leslie must report her suspicion to her supervisor or administrator. Any course of action to conceal (not report) may endanger clients or reduce the effectiveness of intervention (missed treatment sessions, incomplete sessions). ● Complete action: Leslie should follow the institutional policy for reporting impaired professionals. ● Evaluate process and outcome: Ideally the coworker will voluntarily participate in and complete a rehabilitation program for substance abuse. If Leslie is asked to pick up the extra load of clients while her coworker receives treatment for substance abuse, she may be able to negotiate with her supervisor to divide the load with other therapists or prioritize who receives treatment first. Confidentiality and autonomy Risa has been trying to treat Mrs. Garcia for 10 days. Mrs. Garcia is an 82-year-old woman who refuses treatment after a stroke, even though she needs therapy to regain functional ability in self-care skills. She insists she does not need to learn how to dress and bathe herself again; that’s what family is for – to take care of you when you cannot take care of yourself. Risa discharged Mrs. Garcia yesterday. Today Mrs. Garcia’s daughter comes to see Risa and to complain that Mrs. Garcia was inappropriately discharged from physical therapy. ● Relevant information: The client is exercising her right to refuse treatment. Her daughter expects the facility to provide treatment. However, anyone viewing this situation may ask for additional information. On the basis of the vignette, it is not clear what level of function Mrs. Garcia is capable of, or what level of care her daughter is prepared to offer and able to provide. What was Mrs. Garcia’s prognosis of functional recovery with standard care? Has she seen a psychologist to determine whether she is depressed or has cognitive deficits that might explain her behavior? ● Type of ethical problem: This may not be an ethical problem, but rather a misunderstanding of Mrs. Garcia’s wishes for her stroke recovery and the expectations of her family. However, the case also highlights the ethical dilemma between the physical therapist’s duty to work in the best interest of her client (beneficence) and the right of a client to determine or refuse treatment (autonomy). ● Ethics theories and approaches: ○ Autonomy – APTA Code, Principle 2C (“Physical therapists shall provide information necessary to allow patients or their surrogates to make informed decisions about physical therapy care”).
○ Autonomy – APTA Code, Principle 2D (“Physical therapists shall collaborate with patients/clients to empower them in decisions about their health care”). ○ Deontological/duty (therapist/facility) and ethics of care also applicable. ● Practical alternative: The consulting physician decided to consult a psychologist, who determined that the patient was competent to make an informed decision concerning her care. A team-family meeting was scheduled with the client, her daughter (and other family members with a vested interest), the physician, nurse, physical therapist, and other professionals to determine and create an action plan that was acceptable to all parties, but especially to the client and her daughter. ● Complete action: Implement the action plan, if the client agrees. Otherwise, the discharge remains in effect. ● Evaluate process and outcome: Consider creating a facility action plan to be implemented if any client refuses two or more therapy sessions. The action plan would identify and facilitate resolution of the problem and modify the therapy program to the client’s satisfaction. Social justice The Metropolitan Rehabilitation Center has instituted a new policy because the center is under new management after it was purchased by a large healthcare organization. Clients insured by Richo Insurance Company can be seen for only two 15-minute units per day, but clients insured by Grant Insurance Company can be seen for unlimited units. Richo reimburses 60% of actual charges, and Grant reimburses 85% of actual charges. Janie is a 28-year-old mother of two children who sustained a traumatic brain injury in a recent motor vehicle accident. She is insured by Richo. Her therapist is concerned that 30 minutes a day is not enough time to maximize Janie’s potential. ● Relevant information: T reatment is limited under the terms of a new facility policy; this is the first case under the new policy. ● Type of ethical problem: Moral distress. The therapist knows the right thing to do, but there is a barrier. A potential ethical dilemma may arise if the policy does not change. ● Ethics theories and approaches: ○ Social Justice: APTA Code, Principle 8B (“Physical therapists shall advocate reducing health disparities and health care inequities, improving access to health care servers”). ○ Deontological/duty (therapist). ● Practical alternative: Advocate for a policy exception or for policy changes and advocate for supporting organizations that meet the health needs of the disadvantaged. Client could be transferred to another facility. ● Complete action: Use APTA Code, Principle 8A – “Physical therapists shall provide pro bono physical therapy services or support organizations that meet the health needs of people who are economically disadvantaged, uninsured or underinsured”). ● Evaluate process and outcome: Consider notifying state facility licensing agency and/or state insurance office of the situation if policy is not changed. Procedural justice Juan is a physical therapist working in a rural school district where there are no other school-based professionals except the classroom teachers. Elena is a first-grade student who has mild cerebral palsy. She is delayed in language skills, reading, and handwriting. During the individualized education program conference, the parents and teacher request that Juan focus on the language and reading skills as well as handwriting because no one else is available.
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Book Code: PTNJ0824
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