considers an action morally right if everyone involved has a favorable outcome. Jeremy Bentham and John Stuart Mill in the 19th century considered that the consequences of possible pleasure and pain led to moral decision-making. Actions are Case study #2 “Ethical Behavior” Brad is working in a skilled nursing facility that admits many Medicare Part A patients for subacute rehabilitation. There are physical therapy orders to evaluate and treat a 76-year- old new patient, Mrs. Sloan, who is post-operative for a total hip replacement. The patient arrived last night and has been resting comfortably. The nursing staff informs Brad that Mrs. Sloan refused to get out of bed this morning, and they would like his help in transferring her into a wheelchair. Brad sees Mrs. Sloan, who says that she won’t get out of bed and doesn’t want therapy; she just wants to go home. Even after Brad explains the benefits of therapy and informs her that she needs to be able to walk before she can be released, Mrs. Sloan continues to refuse therapy. What does Brad do? Discussion Points: Brad’s ethical dilemma Applying virtue theories to Case Study #2, Brad might try to find other motivating factors to convince his patient to participate by mentally putting himself in her shoes and trying to relate to her
morally right if all participants are benefited,with a net result of happiness. With consequentialist theories, individuals make the correct moral decisions based on perceived outcomes, or consequences. own goals and desires. Using duty theories, he might conclude that his moral obligation rests with respecting Mrs. Sloan’s right to refuse treatment, and he might approach her again at a later time. Using consequentialist theories, there are different outcomes: Social contract theory may direct Brad to force the patient to get up with the help of the nursing staff, so he would benefit by “getting the job done.” Ethical altruism theory might direct him to ask a different therapist to approach the patient, trying to appeal to Mrs. Sloan from a different perspective for her good in the long run. Utilitarianism might suggest that Brad approach the nursing staff to ensure that Mrs. Sloan has taken her pain medications and then begin with bedside exercises to engage the patient’s trust and cooperation for mutual benefit. There is no one correct answer to this scenario, but combining the analysis of his own natural tendencies with the understanding of these theories may help Brad to be better able to cope with ethical dilemmas in patient care.
APPLICATION OF ETHICS IN HEALTHCARE
Applied ethics involves the analysis of specific and possibly controversial moral issues in a given context. Ethics may be applied in a variety of settings, including medicine, business, and the environment. Medical ethics may concern issues such as patient rights,confidentiality of medical records, a physician’s responsibility to tell the truth, abortion, euthanasia, animal rights in medical research,and other life and death decisions. Business ethics may concern issues such as employee rights, job discrimination, deceptive advertising, drug testing, and affirmative action. Environmental ethics may concern issues such as animal experimentation, land usage, and oil drilling. Ethical principles In biomedical ethics, there are primary ethical principles that offer guidance to physical therapists and other healthcare practitioners. These principles include beneficence, nonmaleficence, autonomy, and justice. These principles are incorporated into The APTA Code of Ethics for the Physical Therapist (The Code ; APTA, 2020a) which will be discussed in detail in the next section. Select examples are included here to illustrate how these principles underpin the APTA Code . 1. Beneficence . The principle of beneficence implies acting for the good of the patient. The term beneficence connotes acts of mercy, kindness,and charity (Beauchamp & Childress, 2019). The principle of beneficence is at the heart of healthcare professionals, as the goal of medicine is to promote the well-being of patients (Beauchamp & Childress, 2019). Examples of beneficence include promoting health and welfare of the patient, removing harm, and putting the patient’s best interest ahead of their own. Principle 2A from the Code incorporates this principle by stating that “Physical therapists shall adhere to the core values of the profession and shall act in the best interests of patients and clients over the interests of the physical therapist” (APTA, 2020a). 2. Nonmaleficence . Nonmaleficence obligates healthcare professionals to refrain from causing harm, injury, or risk of harm to patients. Harm can be defined as “thwarting, defeating, or setting back some party’s interests” (Beauchamp & Childress, 2019, p. 158). In healthcare, negligent behavior can lead to harm by either knowingly failing to protect a patient from harm, or by carelessly or accidentally causing harm. From the Code , Principle 3C speaks to this principle by stating “Physical therapists shall make judgments within their scope of practice and level
Regardless of context, the application of ethical principles is similar. The normative principles of applied ethics include consideration of potential personal or social benefits as well as behaving with benevolence (acting for the benefit of others),honesty (truthfulness, uprightness, fairness), autonomy (the duty to maximize the individual’s right to make decisions), and justice(the duty to treat all fairly). The additional guiding standards of nonmaleficence (do no harm) and respect for other people’s rights during the analysis of moral dilemmas transcend the setting in which ethical principles are applied. of expertise” (APTA, 2020a). Failing to do so could lead to harm. 3. Autonomy . The principle of autonomy stipulates respect for a person’s freedom of self-determination (Spike & Lunstroth, 2016). This means that the patient has the right to make decisions regarding their healthcare. Important aspects of this principle include informed consent and confidentiality. The Code speaks to the principle of autonomy in the following examples: ○ Principle 2C : “Physical therapists shall provide the information necessary to allow the patients or their surrogates to make informed decisions about physical therapy care or participation in clinical research.” ○ Principle 2D : “Physical therapists shall collaborate with patients/clients to empower them in decisions about their healthcare.” 4. Justice . The principle of justice is complex and vast and includes the principle of distributive justice. While justice connotes fair and appropriate treatment, distributive justice is described as “fair, equitable, and appropriate distribution of benefits and burdens”(Beauchamp & Childress, 2019, p. 268). The implies a focus on striving to minimize the effect of social inequality on healthcare. In the APTA Code , Principle 8, as shown below, states that “physical therapist shall participate in efforts to meet the health needs of people locally, nationally or globally,” and in Principle 8A that “physical therapists shall advocate to reduce health disparities and healthcare inequities” (APTA, 2020a).
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