Chapter 1: Ethical Issues and Decision Making 2nd Edition (Mandatory) 5 CE Hours
By: Bruce H. Greenfield, PT, PhD, FNAP Learning objectives After completing this course, the learner will be able to: Identify the differences and commonalities among morality, values, ethics, and the law. Describe the purpose and limitations of the American Physical Therapy Association (APTA) Code of Ethics for Physical Therapists. Identify types of ethical problems and issues in physical therapy. Course overview John works as a physical therapist in a small, privately owned physical therapy practice. Besides John, the professional staff includes the owner, Bill, a physical therapist, and June, a physical therapy assistant. John has worked in this practice 5 years and has developed a close relationship with Bill as a friend and mentor. June has been working there 3 months. Everybody seemed to have a good working relationship. Therefore, John was perplexed when June approached him in private and told him that since she began working at the practice, Bill has been making inappropriate sexual remarks to her; for example, commenting on her figure and suggesting that she should wear tight clothes to accent her backside and breasts. At this point, June did not know what to do. She really enjoyed and needed this job and was reluctant to confront Bill. She also did not want John to talk with Bill about this, because she did not want to make things worse. John was unsure about the right course of action. For physical therapists like John, there may be confusion about the most ethical course of action. What is his primary duty in this case? How should he respond to June? What are his obligations to his organization and to his profession? Is there a legal duty in this case? What other information would John need to make a justified decision? The responses to these and similar questions have to do with what it means to be an ethically engaged healthcare professional. Clinicians use ethics to examine issues and human behaviors based on values. Ethics involves making decisions about what is right or wrong, good or bad, and otherwise providing a justification for an ethical decision (Doherty & Purtilo, 2016). Because clinical judgments are invariably value laden, ethics figures strongly into the professional lives of physical therapy practitioners. Research, for example, demonstrates that expert clinicians use ethical reasoning as part of their critical thinking (Jensen, Resnik, & Haddad, 2008). The application of evidence to practice entails a clinician’s best judgment about what to do and when to do it, based on the needs and values Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender,
Describe the ethical approaches, theories, and principles that can guide the physical therapy practitioner in making an ethical decision. Evaluate ethical issues based on an ethical decision-making model. Describe future considerations in ethical decision making.
of each client (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). Across all practice, educational, and research settings, physical therapy practitioners face issues that involve ethical questions. To navigate effectively and safely through ethical issues and problems, physical therapy practitioners should be well versed in the knowledge and skills of ethical decision making. This includes an understanding of their ethical and legal responsibilities under the APTA Code of Ethics for Physical Therapists (APTA, 2010b), APTA Guide for Professional Conduct (2010a), APTA Standards of Ethical Conduct for the Physical Therapist Assistant (2010d), the APTA Guide for Conduct of the Physical Therapist Assistant (2010c), and individual states’ practice acts. Although ethics education has become better integrated into physical therapy education over the past decade, many educators believe that, because of increasing professional autonomy and independence in clinical decision making and judgments, physical therapists face increasingly complex ethical issues in clinical practice. As a result, a gap remains between ethics knowledge and practice (Delany, Edwards, Jensen, & Skinner, 2010). Adding to the ethical theory-practice gaps in physical therapy is the increasing interdisciplinary nature of the clinical environment that requires decisions to be made in the best interest of the clients and within a web of health professionals (Banks, 2010) . Adding to this gap is the increasing focus on client-centered care, the extent and boundaries of client autonomy in clinical decision making (Young et al, 2017), the rapid development of technology and genomics integrated into rehabilitation (Greenfield & Musolino, 2012), and the ethical implications of value-based practice payments (Nathanson, 2015). This intermediate level course provides physical therapists and physical therapist assistants with an updated primer on the study of ethics and ethical behaviors as they apply to physical therapy practice. The course is designed to help clinicians effectively and efficiently integrate ethical decision making into their clinical practice. or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients
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Book Code: PTNJ0824
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