● Fidelity: The principle of fidelity comes from the Latin root fides, which means faithfulness. Fidelity therefore is being faithful to one’s commitments. Physical therapy personnel have obligations of fidelity to be faithful to their fiduciary responsibility to work for the best interests of their patients/ clients (Doherty & Purtilo, 2016). ● Fiduciary: A fiduciary relationship is a legal and ethical concept. In such a relationship, a “person in whom another person has placed a special trust or confidence is obligated to watch out for the best interests of the other party” (Doherty & Purtilo, 2016, p. 250). ● Harm: “Thwarting, defeating, or setting back some party’s interests” (Beauchamp & Childress, 2013, p, 153). Interests may include reputation, property, privacy, and liberty. Harmful actions are usually, but not always, wrong. Some harmful actions involve justifiable setbacks to another’s interests to achieve a more desirable goal such as demoting an employee for poor performance or removing a license to practice because incompetent care was provided. ● Law: Government defines law, based on concepts of justice and equality and representing the minimum standards of behaviors that society is willing to enforce (Doherty & Purtilo, 2016). ● Locus of authority: A locus of authority problem arises from the ethical question regarding who should have the authority to make an important ethical decision. That is, who is in charge and is the rightful moral agent. Locus of authority is often based on professional expertise, traditional arrangements, institutional arrangements, or the authority of experience (Doherty & Purtilo, 2016). ● Malpractice: An instance of negligence that involves not following professional standards. ● Moral character (virtue): Traits and dispositions or attitudes that enable us to trust each other and that provide for human flourishing in times of stress. These characteristics include compassion, courage, honesty, faithfulness, respectfulness, humility, and other ways of being in the world that we want to be able to count on (Doherty & Purtilo, 2016). ● Moral distress: Focuses on a situation that blocks a person (moral agent) from doing what he or she knows is right (Doherty & Purtilo, 2016 ). ● Moral values: Moral values include compassion, courage, altruism, honesty, fairness, and integrity. The APTA document Professionalism in Physical Therapy defines professional core values (APTA, 2012b). These are accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility. These core values form the foundation for the ethical principles set forth in the APTA Code of Ethics for the Physical Therapist ( see also values). ● Morality: Morality is concerned with relationships between people, and ultimately how people can best live in peace and harmony (Doherty & Purtilo, 2016 ). ● Narrative approach: An important step in making an ethical decision is to “get the story” straight. That means expanding Note : There are many Internet sites that contain and discuss information about health care and medical ethics. The websites listed are representative but not comprehensive. ● APTA Core Ethics Documents http://www.apta.org/Ethics/Core/ These documents include the APTA Code of Ethics for the Physical Therapist; APTA Guide for Professional Conduct; APTA Guide for Professional Conduct for the Physical Therapy Assistant; Standards of Ethical Conduct for the Physical Therapist Assistant; and Revision to the Code and Standards. Resources Websites
the narrative of a case to fill in “gaps” in the story. The narrative approach to ethics is based on the observation that humans are storytelling creatures by nature and pass on information by sharing stories to make sense of experiences (Polkinghorne, 1988). ● Negligence: The absence of due care. In the professions, negligence involves a departure from the professional standards that determine due care in given circumstances (Beauchamp & Childress, 2013). ● Nonmaleficence: Not harming or causing harm to be done to oneself or others; the duty to ensure that no harm is done (Slater, 2011). ● Obligation: A professional duty to abide by the Code of Ethics for the Physical Therapist (Doherty & Purtilo, 2016). ● Procedural justice: The assurance that processes are organized in a fair manner (Slater, 2011). ● Professional ethics: Rules of acceptable conduct that members of a given profession are expected to follow (VanderBos, 2007). ● Rights: Specific legal, moral, and social claims humans possess that require others to act in specific ways toward us. With all rights is the implied obligation or duty on the part of each of us (Doherty & Purtilo, 2016). ● Standards of practice (standards of care): A set of guidelines that delineate the expected techniques and procedures, and the order in which to use them, for interventions with individuals experiencing a range of psychological, medical, or educational conditions (VanderBos, 2007). ● Teleology (teleological theory): ( telos, end). An ethics theory that focuses on outcomes or consequences. This classical theory states that the morally right action is determined by the outcome it produces; frequently stated as “the ends justify the means” (Slater, 2011). See also consequentialism. ● Utilitarianism: An ethical theory that states that right actions are those that maximize utility (the greatest good for the greatest number) and result in the best consequences for all involved (Slater, 2011). See also consequentialism and teleology. ● Values: Values are beliefs that a person, group, or society holds dear (Rokeach, 1973) and are often culturally shaped and instilled through an individual’s family, community, school, and religion. ● Veracity: A duty to tell the truth (Slater, 2011). Veracity in the healthcare setting refers to comprehensive, accurate, and objective transmission of information, as well as to the way the professional fosters the patient’s (client’s) or subject’s understanding (Beauchamp & Childress, 2013). ● Virtue ethics: A form of philosophy that emphasizes character and personal integrity; involves deliberation, the quality of choice, and one’s responses to one’s poor choices (Slater, 2011). See also character-based ethics. ● APTA Ethics Interpretation and Opinions and Ethics in Practice Articles by Principles and Standards http://www.apta.org/EJCOpinions/ This website provides opinions on ethical issues by the APTA Ethics and Judicial Committee (EJC). Ethics in Practice articles, which are featured regularly in PT in Motion, are also found on this website. Ethics in Practice articles promote PTs’/PTAs’ ability to engage in ethical decision making. ● Bioethics Discussion Blog http://bioethicsdiscussion.blogspot.com/ Bioethical issues may have significance for all of society, and therefore the general public, as well as ethicists, should get involved and express what they think. On this website, participants may write about any of the topics or invite discussion with a new topic.
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