APPLIED ETHICS IN PHYSICAL THERAPY
The principles of medical or healthcare ethics provide guidelines that can help in the resolution of moral dilemmas. Physical therapists are in a unique position with patient care issues, because PTs often act as liaisons between patients and their family members, physicians, and other healthcare practitioners. Patients are physically and mentally vulnerable when the need for therapeutic intervention arises, and the treating physical therapist or physical therapist assistant must be aware of the level of trust the patient places in them. Patients share their current and past medical history, describe their home situations, and present their bodies for inspection. Occasionally, they state their perceptions of the therapist’s fellow healthcare workers’ attitudes and actions. Most of the time, they quickly come to regard the therapist as a friend and trust the physical therapist or physical therapist assistant to keep their opinions, hopes, and fears confidential. Case study #3 “Professional Boundaries” Fran is a physical therapist who has been practicing for two years in a large neurological rehabilitation center. She enjoys treating neurologically-impaired patients, and gets along well with the other therapists working there, although she still thinks of herself as a“new grad.” On occasion, she feels uncomfortable when some of the therapists talk to each other about other patients during treatment sessions. One day, Fran notices family members exchanging looks when two of her coworkers share a private joke about a patient while treating their loved one who is recovering from a head injury.
Therapists must continually regard the patient with respect, and protect the patient’s autonomy at all times. It is important to treat patients with care and compassion, and to provide an environment of support. Patients should be able to feel safe and secure in the knowledge that their cases are being treated confidentially. Therapists need to inform and educate patients about their condition,effectively empowering and allowing them to make informed decisions. A physical therapist or physical therapist assistant explaining their logic and actions before physically approaching the patient not only allows the patient to feel respected, but also decreases the potential for lawsuits in the event that the patient misconstrues the therapist’s actions. The Golden Rule provides overall guidance inpatient interaction, as it is helpful for a physical therapist or physical therapist assistant to consider how they might like to be treated or to have a beloved family member treated in a similar circumstance. Discussion Points: Setting professional boundaries with Fran What does Fran do? Is there a way to tactfully approach her peers and remind them of respecting confidentiality? Can Fran defuse the current situation? If the other therapists are behaving so casually during this patient’s treatment, could there be times when patient confidentiality is breached? Fran wonders how she would feel if one of her relatives were being treated with apparent indifference or disrespect.
THE APTA AND ETHICS
Professional organizations establish a code of ethics to set a specific standard by which the conduct of its members can be measured. The APTA’s House of Delegates has identified standards for physical therapists in the Code of Ethics for the Physical Therapist (the Code ; APTA, 2020a) and for physical therapist assistants in the Standards of Ethical Conduct for the Physical Therapist Assistant (the Standards ; APTA, 2020b). These standards are further illuminated in the APTA Guide for Professional Conduct (APTA, 2019a) and APTA Guide for Conduct of the Physical Therapist Assistant (APTA, 2019c). Although not all physical therapists are APTA members, the Code and Standards are binding on all physical therapists and physical therapist assistants regardless of membership status. As a group, physical therapists tend to be people of integrity, with a strong sense of personal ethics and a desire to help others. The Code describes virtues, obligations, and moral ideals for the physical therapist to aspire to and be guided by. The purpose of both codes is to define ethical principles that form the foundation of physical therapy practice and to provide standards of ethical behavior as it relates to physical therapy. The APTA Code of Ethics for the Physical Therapist is built on APTA Code of Ethics The following section provides the preamble to the Code of Ethics for the Physical Therapist (APTA, 2020a) and lists the eight main principles of the Code . Each principle is further divided into subsections that elaborate on the main principle. The principles found in the Standards of Practice for the Physical Therapist Assistant are very similar and are not provided here. To view the Code and other APTA ethics and professionalism documents in their entirety, see the Resources section for links. Preamble The Code of Ethics for the Physical Therapist (Code of Ethics) delineates the ethical obligations of all physical therapists as determined by the House of Delegates of the American Physical Therapy Association (APTA). The purposes of this Code of Ethics are to: 1. Define the ethical principles that form the foundation of physical therapist practice in patient and client
the roles of the physical therapist (e.g. management of clients, consultation, education, research, and administration). In the document Core Values for the Physical Therapist and Physical Therapist Assistant (APTA, 2019b), the APTA has defined eight professional core values that guide Physical Therapy (PT) practice and support the ethical principles set forth in the APTA Code of Ethics for the Physical Therapist : ● Accountability. ● Altruism. ● Collaboration. ● Compassion/caring. ● Duty. ● Excellence. ● Integrity. ● Social responsibility. The core values that support the eight principles in the APTA Code and Standards are indicated in parentheses below. The principles in both of these ethics documents address individual, organizational, and societal ethical actions. management,consultation, education, research, and administration. 2. Provide standards of behavior and performance that form the basis of professional accountability to the public. 3. Provide guidance for physical therapists facing ethical challenges, regardless of their professional roles and responsibilities. 4. Educate physical therapists, students, other health care professionals, regulators, and the public regarding the core values,ethical principles, and standards that guide the professional conduct of the physical therapist. 5. Establish the standards by which the American Physical Therapy Association can determine if a physical therapist has engaged in unethical conduct.
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