CODES OF ETHICAL CARE
Codes of ethics are created by professional groups to organize the ideas about ethics that are viewed as most important within that profession. A code of ethics is “a set of standards and principles of professional conduct” (VanderBos, 2007, p. 185). Professional codes of ethics within health care usually have four purposes (Scott, 2009). The code: 1. Provides guidance regarding mandatory behavior expected of members while performing various roles and functions in the work setting. 2. States the rights of persons with whom members interact, such as clients, research participants, students, employees, colleagues, or the public at large. 3. Addresses ethical problems, issues, and dilemmas particular to the profession, such as when to initiate and terminate service. 4. Includes provisions for enforcing the code, either within the code itself or a companion document. Enforcement may be subdivided into several categories depending on the perceived severity of the infraction of the code. The APTA Codes of Ethics for the Physical Therapist The APTA Code of Ethics for the Physical Therapist and the Standards of Ethical Conduct for the Physical Therapist Assistant are the two major codes of ethics adopted by the APTA House of Delegates. The Code and Standards are primarily aspirational codes. The purpose of both codes is to define ethical principles that form the foundation of physical therapy practice and to provide standards of behavior guidance for ethical challenges and standards of ethical conduct. The principles in the APTA Code of Ethics for the Physical Therapist and the Standards of Ethical Conduct for the Physical Therapy Assistant are further interpreted in the APTA Guide for Professional Conduct and the APTA Guide for Professional Conduct for the Physical Therapy Assistant, respectively. These core ethics documents can be found at http://www.apta.org/Ethics/Core/ Because professions and society may change their ideas over time about morality and about which moral actions are considered right or wrong under different circumstances, a professional code of ethics must be reviewed and updated periodically to reflect these changing ideas. Updates are designed to modify, clarify, and expand the thinking of physical therapy practitioners and the actions they take with clients. In 2006, members of the APTA Ethics and Judicial Committee (EJC) recognized that the Code of Ethics for the Physical Therapist in effect at that time focused primarily on the client-practitioner interaction and did not give guidance for therapists’ roles as educators, consultants, and administrators. In addition, they acknowledged that the code did not: ● Provide guidance for the expanded responsibilities of therapists related to autonomous practice as described in Vision 2020. ● Recognize the complexities in contemporary healthcare delivery. ● Address concerns at the institutional and societal level. ● Capture a contemporary notion of relationships with other health professionals. ● Address the unique moral obligations of the physical therapy (PT) profession. Therefore, they requested that the APTA board of directors appoint a task force to study the Code and propose revisions. The APTA appointed a task force, cochaired by Hiller and Swisher, in 2007, and a revised document was presented to the House of Delegates and subsequently adopted in 2009. This revised Code, which incorporated the core values, became effective July 1, 2010 (Swisher & Hiller, 2010).
There are three types of codes of ethics: aspirational, educational, and regulatory. Aspirational codes encourage competent and moral behavior but do not provide guidelines for ethical conduct or sanctions for failure to follow the intent of the code. Educational codes state what constitutes ethical behavior and may provide case examples as illustrations but do not provide sanctions for failure to follow the code. Regulatory codes spell out the expected behavior, state guidelines for expected conduct, and give specific descriptions of sanctions for failures to follow the code (Reed & Slater, 2011). Historically, professional organizations have developed codes of ethics to strengthen their professional identities and to demonstrate their commitment to ethical practice toward the public good (Swisher & Hiller, 2010). The American Medical Association’s Code of Medical Ethics published in 1846 became the prototype for the first Code of Ethics of the American Physiotherapy Association (APA) published in 1935. The most recent revision of the American Physical Therapy Association (APTA) Code of Ethics for the Physical Therapist was adopted in 2009 and became effective on July 1, 2010 (Swisher & Hiller, 2010). The revised APTA Code of Ethics for the Physical Therapist is built on the five roles of the physical therapist (management of clients, consultation, education, research, and administration). Fundamental to the Standards of Ethical Conduct for the Physical Therapist Assistant is the special obligation to enable clients to achieve greater independence and quality of life. In Professionalism in Physical Therapy: Core Values (http:// www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/ Judicial_Legal/ProfessionalismCoreValues.pdf), the APTA has defined seven professional core values that guide PT practice and support the ethical principles set forth in the APTA Code of Ethics for the Physical Therapist: ● Accountability. ● Altruism. ● Compassion/caring. ● Excellence. ● Integrity. ● Professional duty. ● Social responsibility. Throughout the Code of Ethics for the Physical Therapist, the primary core values that support ethical principles are indicated in parentheses. The principles in both the Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapy Assistant address individual, organizational, and societal ethical actions. The Code is binding on all physical therapists, regardless of APTA membership. However, sanctions for violations of the Code can be imposed only on members of the APTA. Provisions for sanctions are mandated in the APTA bylaws through the EJC and also through an APTA document, Disciplinary Action Procedural Document (2012a), which clearly outlines provision for sanctions against members of the APTA who violate the Code of Ethics for the Physical Therapist. Sanctions are against membership rights and privileges. These sanctions include reprimands, probation, or suspension or expulsion from APTA membership. The APTA Code of Ethics for the Physical Therapist may be codified in part or whole into a state licensure law. When codified in state law, the sanctions are against the license of the therapist and affect the legal ability to practice. The regulatory component depends on the sanctions that are specific to a particular state licensure law. Sanctions that a legal entity (e.g., a state licensure board) may apply include requiring a person to attend continuing education courses, perform a
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