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Ethical Issues and Decision Making, 2nd Edition: Summary
ETHICAL APPROACHES AND THEORIES • Narrative approach: “Get the story straight” by filling in the gaps in the story • Caring approach: The goal of making an ethical decision is to make a caring response due to the fiduciary role between therapists and patients ○ Example: In discussing her interactions with a client who refuses treatment, a physical therapist states: “I try to discuss and understand his reservations and fears about this treatment. I describe the benefit of treatment and try to reach a compromise that we both can accept” • Deontology: Based on principles and duties without regard to consequences ○ Example: A physical therapist who acts in a certain way based on his perceived duty, regardless of its outcome • Teleology: Based on consequences or “ends”; actions seek the best or least harmful consequence • Virtue ethics: Actions based on certain virtues (courage, integrity, temperance, liberty, wisdom) Ethical Principles • Beneficence: Acting in the client’s best interests. Examples of beneficence include protecting and defending the rights of others, preventing harm from occurring to others, removing conditions that will cause harm to others, helping persons with disabilities, and rescuing persons in danger • Nonmaleficence: To refrain from hurting others (causing harm, inflicting injury, or wronging others). This can include discomfort, humiliation, offense, and annoyance in some situations ○ Due care: Taking sufficient and appropriate care to avoid harm ○ Negligence: The absence of due care. It may be intentional or unintentional
○ In a situation like this, the therapist who suspects inappropriate behavior must have evidence. Protocols need to be followed—not only institutional protocols and Code of Ethics for the Physical Therapist. In addition, most state practice acts have an impaired practitioner clause and specify steps to report substance abuse • Business Relationships and Economic Considerations Case Example Mary is a physical therapist who recently took a position with a home health agency. The agency has negotiated a value-based payment (VBP) model with Medicare that incentivizes cost- effective care. The VBP provides incentives for a few specific elements of a single disease or condition that may neglect the complex care needed for the whole patient. Mary is treating an elderly woman to restore function following a hip fracture. Although the patient’s Medicare reimbursement has an established cost-containment model that rewards outcomes based on cost, Mary’s patient presents with multiple comorbidities that contribute to a slow recovery. Mary is faced with moral distress and a moral dilemma in that her company wants to discharge the patient within the standard parameters and time constraints established by the VBP for patients with hip fractures. Mary believes that the complexity of conditions presented by this patient does not fit the VBP for her primary condition and requires additional physical therapy. ○ What are the physical therapists’ obligations and justifications? What would be the most practical action to take and why?
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