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Ethics for the Pennsylvania Physical Therapy Professional: Summary
THE REALM-INDIVIDUAL PROCESS- SITUATION (RIPS) MODEL OF ETHICAL DECISION MAKING Realm Individual: Concerned with the good of the patient/client and focus on rights, duties, relationships, and behaviors between individuals. It deals with the least complex problems. Organizational/Institutional: Concerned with the good of the organization and focused on structures and systems that will facilitate organizational or institutional goals. Societal: Concerned with the common good; the most complex realm. What Is the Individual Process? Ask: What does the ethical situation most require of me? Is it to recognize the ethical situation (moral sensitivity)? To make a decision about right or wrong (moral judgment)? To put moral values above other values (moral motivation)? Or whether to implement my decision or take action at all (moral courage)? It may also be important to evaluate the moral processes of others involved in the situation. Example: Are there significant moral temptations for others that would require moral courage? Determine the Type of Ethical Situation Dilemma: Two alternative courses of actions may be taken, both of which fulfill an important duty, and it is not possible to fulfill both obligations. Known as the “right versus right” decision. Distress: You know the right course of action but are not authorized or empowered to perform it. Note that ethical distress may be present as a later complication of any of the ethical situations. Ethical distress is often identified during the implementation phase of decision making. Temptation: Involves a choice between a “right” and “wrong” in which you may stand
CASE ANALYSIS 3: Consider the case of a lady who has been diagnosed with terminal cancer and has been given three months to live. She is a married mother of three and has shared her diagnosis and prognosis with her husband but does not want to share the information with her three children: a boy, 17; a girl, 15; and a boy, 10. You, as a healthcare professional, personally believe that your patient should share her prognosis with her children in order to give them a chance to say goodbye. On a personal level, you also believe that she should tell her children that she will likely die. • Given that your patient does not want her children to know her prognosis, what should you do? Is it ethical to withhold information from the children? Is your patient your only obligation? Should you tell the children, or should you keep your patient’s secret? • Honesty could mean that when the children, or other family members, ask how your patient is doing, you may need to direct their inquiries to the patient and/or her husband. • Your primary obligation is to your patient. You must respect her wishes. However, it is ethical to encourage her to share her prognosis with her children. In this way, you have maintained honesty in an ethical manner.
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