specified number of community service hours, participate in a rehabilitation program for substance abuse, pay a monetary fine,
refrain from practice for a certain length of time, or permanently stop practicing as a physical therapist.
Limitation of the APTA Code of Ethics for the Physical Therapist Physical therapy personnel who use the Code of Ethics for the Physical Therapist to navigate ethical issues should be aware of the limitations of the Code in helping them solve an ethical problem (Greenfield & Jensen, 2010). One problem is that multiple principles that are contained in the Code and applied to an ethical situation may be equally compelling to a physical therapist. As a result, a physical therapist is faced with choosing between conflicting duties and justifying his or her choice. Second, the Code does not describe how physical therapists
The authors also suggest that invariably healthcare professionals will have to balance or weigh which ethical principle would best apply to achieve a justifiable outcome. These processes suggest the importance of understanding all the dimensions of an issue and ultimately making a practical judgment. Specifically, the Code alone is necessary but insufficient to make an ethical decision. The clinician needs to have knowledge of an ethical framework or decision-making model to make an ethical decision that he or she can reasonably justify. The APTA Ethics Page and APTA website for Ethical Decision-Making (see the Resources section) provide several tools to help physical therapy personnel make sound ethical decisions. These include Consensus Statement on Clinical Judgment in Health Care Settings, EJC Opinions in Practice articles, and Realm Individual Process- Situation (RIPS) Model of Ethical Decision Making.
apply ethical principles or specify rules to solve an ethical problem. As mentioned, principles sometimes may conflict with each other and will require further judgment to arrive at an ethical conclusion. To address the problem of conflicting principles, Beauchamp and Childress (2013) suggest that healthcare professionals must look toward the context of each case and specify how a particular principle may best apply.
DIMENSIONS OF ETHICAL PROBLEMS IN PHYSICAL THERAPY
How can physical therapy practitioners know if a situation involves an ethical versus a legal problem or perhaps a problem simply involving miscommunication? How does an individual recognize an ethical question that needs to be solved? Broadly speaking, ethical questions, according to Doherty and Purtilo Prototypical ethical problems To help clarify ethical questions, Doherty and Purtilo (2016) describe three prototypical ethical problems: moral distress, locus of authority, and an ethical dilemma. A prototype is a category that contains a set of necessary and sufficient conditions, dimension, or characteristics (Johnson, 1993). Prototypes are useful in ethics because they help clinicians sharpen the distinction of an ethical issue by clarifying the characteristics and dimensions of a problem or problems that must be navigated to make a successful decision. One of the initial steps in making an ethical decision is to define the type of ethical problem one is dealing with. Moral distress Moral distress occurs when a situation presents a barrier that blocks a clinician from doing what he or she perceives is right (Doherty & Purtilo, 2016). The barrier can result from an external source or from an internal source. In either case, the clinician experiences emotional, cognitive, and sometimes physical distress. For example, in the case above, John faces internal moral distress because he is uncertain about what the proper course of action is. He knows something is wrong, but the most appropriate course of action is a big question mark. Principle 4C of the APTA Code of Ethics for the Physical Therapist (2010b) states that “physical therapists shall seek to discourage misconduct by healthcare professionals and report illegal or unethical acts to the relevant authority, when appropriate.” Is it appropriate to report this case when it is not certain that the facts are clear? And who is the relevant authority in this case? According to the APTA Guide for Professional Conduct (2010a), the relevant authority can include a number of people or entities, including your supervisor, human resources, your attorney, the Equal Employment Opportunity Commission, the Licensing Board, the Better Business Bureau, the Insurance Commissioner, the Medicare Hotline, Office of the Inspector General (OIG) Hotline, the U.S. Department of Health & Human Services, an institution using their internal grievance procedures, the Office of Civil Rights, or another federal agency, state agency, a city or local agency, or a state or federal court. Who should John turn to first? Principle 4C also states that reporting should occur “when appropriate” (APTA, 2010b). The problem in this case is that reporting may not be appropriate because John does not know all the facts. He is also not certain about this legal obligation and
(2016) can be distinguished from strictly legal or clinical questions because ethical questions place the focus on the individual’s role as a moral agent and on those aspects of the situation that involve moral values, duties, and quality-of-life concerns in an effort to arrive at a caring response. may not want to assume legal responsibility when the matter can be resolved internally. Locus of authority A locus of authority problem arises from the ethical question of 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). In professional health care, which has been traditionally viewed hierarchically, with the physician assumed to be the ultimate source of authority in clinical decisions about client care, physical therapists have often struggled in their professional roles to recognize their boundaries of decision making and care. John may not be certain that he has the professional authority to make an ethical choice in responding to June on the basis of his perception of his role on her healthcare team. It appears that the APTA Code of Ethics for the Physical Therapist provides clear guidance about John’s obligation in this scenario based on Principle 4C, which stipulates that “Physical therapists shall discourage misconduct by health professionals…” (APTA, 2010b). Ethical dilemmas Ethical dilemmas comprise the third prototypical category and are often the most challenging for clinicians to solve. An ethical dilemma occurs in the presence of an ethical conflict when one must decide a course of action by balancing two or more values, or ethical principles (obligations), that both equally apply (Doherty & Purtilo, 2016). For example, an ethical dilemma arises when a physical therapist has to balance his responsibility to continue caring for a client when therapeutic goals have not been met but reimbursement funds have run out. In the case vignette, it does not seem that John faces an ethical dilemma. Based on Principle 4C it is clear that John has to act. The challenge is what his appropriate course of action is. Physical therapy practitioners often encounter situations in which types of ethical problems overlap. The overlapping of moral problems makes ethical decision making a messy and often emotional experience for many, a situation that is often exacerbated when the physical therapy practitioner lacks the knowledge and skills of ethical decision making.
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