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Ethics for the Pennsylvania Physical Therapy Professional: Summary
to benefit from doing the wrong thing. Known as the “right versus wrong” decision. Silence: Ethical values are challenged, but no one is speaking about this challenge to values. This may actually be the course taken by an individual who is experiencing moral distress. Steps of the RIPS Model Step 1: Recognize and Define the Ethical Issue • Realm • Individual process • Implications for action • Type of ethical situation • Barrier Step 2: Reflect • Background • Major stakeholders • Consequences of action or inaction • Laws broken? • Professional guidance • Right-versus-wrong tests ○ Legal test: Is something illegal? (Refer to Practice Act and the Rules). If so, it is probably not a true dilemma but a “hard choice.” ○ Stench test: Does it feel wrong, such as a “gut” reaction? ○ Front-page test: How would you like this on the front page of your local newspaper? ○ Mom test: If I were my mother (or parent), would I do this? ○ Professional ethics test: Do the Code of Ethics, Guide for Professional Conduct for the PT, Standards of Ethical Conduct, Guide for Conduct of the PTA, or Core Values prohibit or discourage the action? Step 3: Decide the Right Thing to Do Step 4: Take Action • Implement • Evaluate • Assess needed changes to prevent recurrence
In this step we might also need to examine the policies of the facility or employer to determine whether those policies are sufficient to protect both patients and staff. CASE STUDY APPLICATION OF THE RIPS MODEL: HELEN Helen L. has just left the office of a local orthopedic surgeon. She had hoped to illustrate her quality outcomes in order to encourage referrals. Midway through the visit, it became clear that the physician was unenthusiastic about positive outcomes of her private practice. Helen had the clear impression that the MD expected some kind of gift—in fact, he almost stated bluntly that he would need tee times at the exclusive country club to consider her request. Helen wonders if she is just being naïve—perhaps she should just “play the game.” R ealm: Societal/organizational—The problem is within the for profit health care system and the lack of regulation of gifts for referral. Even if Helen successfully negotiates the individual aspects with this MD, it will not resolve the structural problem that permits this practice. Individual Process: Moral courage— Helen appears to believe that there is a right-versus-wrong component but is concerned about the financial consequences as well. Situation: Moral temptation: Helen may first perceive this as an ethical dilemma— whether to save her practice (employee, jobs, and patient care) by complying with the MD or to obey professional standards regarding gifts to referral sources. It is a right-versus-wrong situation. The APTA Guide for Professional Conduct and other regulatory statutes indicate that this practice is unethical and, in some cases, illegal.
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