Louisiana Physical Therapy Ethics

Transcription

1 Louisiana Physical Therapy Ethics Course Description: Louisiana Physical Therapy Ethics was designed to help therapy professionals with the ethical dilemmas they face in the workplace. The course is designed to promote a better understanding of ethics, morals and legal behavior in the hopes of facilitating a better decision making process for professionals in ethical situations. The information also includes the APTA Code of Ethics, the Standards of Ethical Conduct for the Physical Therapist Assistant, the APTA Guide for Professional Conduct, the APTA Guide for Conduct of the Physical Therapist Assistant. Lastly, case studies are provided to help identify appropriate ethical responses/actions to specific situations. Course Author: Mary Smith, RPT Methods of Instruction: Online course available via internet Target Audience: Physical Therapists and Physical Therapist Assistants Educational Level: Intermediate Prerequisites: None Course Goals and Objectives: At the completion of this course, participants should be able to: 1. Define Ethics 2. Define Morality 3. Identify the basic similarities and differences between ethics and morals 4. Differentiate between common ethical theories 5. Define determinants of moral and ethical behavior 6. Understand the ethical decision-making process 7. Interpret and apply the APTA s Code of Ethics 8. Interpret and apply the APTA s Standards of Ethical Conduct for the Physical Therapist Assistant 9. Understand and incorporate the APTA s Guide for Professional Conduct for the Physical Therapist and the Physical Therapist Assistant 10. Apply case studies to help identify appropriate ethical responses/actions to specific situations. Criteria for Obtaining Continuing Education Credits: A score of 70% or greater on the written post-test 1 of 38

2 DIRECTIONS FOR COMPLETING THE COURSE: 1. Review the goals and objectives for the course. 2. Review the course material. 3. We strongly suggest printing out a hard copy of the test. Mark your answers as you go along and then transfer them to the actual test. A printable test can be found when clicking on View/Take Test in your My Account. 4. After reading the course material, when you are ready to take the test, go back to your My Account and click on View/Take Test. 5. A grade of 70% or higher on the test is considered passing. If you have not scored 70% or higher, this indicates that the material was not fully comprehended. To obtain your completion certificate, please re-read the material and take the test again. 6. After passing the test, you will be required to fill out a short survey. After the survey, your certificate of completion will immediately appear. We suggest that you save a copy of your certificate to your computer and print a hard copy for your records. 7. You have up to one year to complete this course from the date of purchase. 8. If you have a question about the material, please it to: info@advantageceus.com and we will forward it on to the author. For all other questions, or if we can help in any way, please don t hesitate to contact us at info@advantageceus.com or of 38

3 Louisiana Physical Therapy Ethics Physical therapy should be black and white right? You go to school, learn how to be a great therapist, graduate with the degree and then rush out to help the world. And usually, it works out that way and both patients and therapists win. But more and more these days, well intentioned physical therapists are running into situations where the lines between right and wrong blur.where situations aren t always black and white.where ethics plays a vital role. As physical therapists become more autonomous in their role as healthcare providers, ethical situations are more likely to arise. This course is designed to educate therapists about ethics, to help them make good ethical decisions and feel confident about those decisions. What IS Ethics?? To understand better the concepts of physical therapy ethics, it is good first to have an overview of the discipline of ethics. The word ethics is coined from the Greek word ethos which means character and from the Latin word mores which means customs. Together, they combine and define how individuals make a choice of interacting with one another. In the field of physical therapy, the study of ethics is categorized into normative or philosophical ethics and social scientific or descriptive ethics. Philosophical ethics mainly deals with what people are supposed to do and how they should carry themselves as well as the rationality in making such decisions. Social scientific ethics on the other hand focuses on the study of human ethical behavior with empirical or social scientific tools aiming at exploring the bases of human objectives and the bases of right and wrong human deeds that enhance or hinder these goals. The significance of ethics is evidential on several levels. First, when people work in an ethical manner, they feel better about their profession and themselves. Second, ethics builds public trust which increases credibility of professions. Third, ethics promotes business at the organizational level. Businesses that are run ethically perform better than those run in an unethical manner. 3 of 38

4 Breaking down the basic definitions. The Definition of Ethics A set of principles designed to determine right or wrong conduct. A theory or a system of moral values. The study of the general nature of morals and of the specific moral choices to be made by a person; moral philosophy. The rules or standards governing the conduct of a person or the members of a profession. The Definition of Moral Being concerned with principles of right and wrong or conforming to standards of behavior and character based on those principles There are several sub-types of morality. Types of Morality Personal: values and duties you adopt as relevant In its first, descriptive usage, morality means a code of conduct which is held to be authoritative in matters of right and wrong. Morals are created and defined by society, philosophy, religion, or individual conscience. An example of the descriptive usage could be "common conceptions of morality have changed significantly over time." Societal: common denominator of shared beliefs In its second, normative and universal sense, morality refers to an ideal code of conduct, one which would be espoused in preference to alternatives by all rational people, under specified conditions. In this "prescriptive" sense of morality as opposed to the above described "descriptive" sort of sense, moral value judgments such as "murder is immoral" are made. To deny 'morality' in this sense is a position known as moral skepticism, in which the existence of objective moral "truths" is rejected. 4 of 38

5 Group: shared by the group you belong to such as work, religious, social and professional groups In its third usage, 'morality' is synonymous with ethics. When confronted with an ethical distress or dilemma that needs a decision, there are really three levels in which an ethical decision needs to be made. 1. An ethical problem is one in which the practitioner is confronted by challenges or threats to his or her moral duties and values. 2. Ethical distress occurs when practitioners know the course of action they should take, but for whatever reason, they do not take it. They may be blocked from being the kind of person that they want to be and cannot do the things that they really want to do or they feel is right. There may be institutional or financial barriers. 3. An ethical dilemma is when there are two morally correct courses of action, but they cannot both be followed at the same time. Ethics versus Morals People often confuse the words ethics and morals sometimes using them interchangeably. Notably though, the two words are not identical. The term morals refer to practices whereas ethics usually refers to the rationale that support or oppose such practices. In short, morals are concerned with actions and ethics with reasoning behind such actions. Ethics is usually at a higher intellectual level, more universal, and more emotionally involved than morals. From time immemorial, man has tried to come up with philosophical bases for determining what is wrong or right. With this several ethical theories have been proposed. Some of generally accepted ethical theories are utilitarianism, social contract theory, deontological theory, ethical intuitionism, ethical egoism, natural law theory and virtue ethics. Utilitarianism is the idea that the moral worth of an action is determined only by what it can contribute to overall utility. Its worth is its contribution to happiness as summed among all people. It is a form of consequentialism, meaning that the moral worth of an action is determined by its outcome. Utilitarianism is sometimes described by the phrase "the greatest good for the greatest number of people". It is commonly known as "the greatest happiness principle". 5 of 38

6 Social contract describes a group of theories that explains how people maintain social order. This theory states that some individuals give up their rights to authority in order for society to maintain a higher and more organized social order. Deontological theory states that all acts are either inherently good or bad, no matter what the end result is. Most deontological theorists believe that we have a duty to do what is inherently good, even if the end result or consequence is bad. Ethical Intuitionism is described as common sense or conscience. It states that an act or decision is ruled as right or wrong depending upon the natural intuition of the individual. Ethical Egoism operates under the idea that each individual must make decisions based on what is in their own best interests. Natural law theory is a philosophical and legal belief that all humans are governed by basic innate laws, or laws of nature, which are separate and distinct from laws which are legislated. It infers that natural law is akin to common sense or intuition. Virtue ethics may be identified as the one that emphasizes the virtues, or moral character, in contrast to the other theories that emphasizes duties or rules. This theory points to how the decision could be good, charitable or benevolent. Determinants of Ethical/Moral Behavior There are basically four components to moral behavior - moral sensitivity, moral judgment, moral motivation and moral character. For a good ethical decision to be made, all four of these components have to be in place. None is more important than the other. All four of them have to be in place to meet the requirement of an ethical decision. 1. Moral Sensitivity Moral sensitivity is the ability to interpret the situation and project the consequences of your actions. If you do not have moral sensitivity, then you do not act ethically because it does not occur that what you are doing is going to affect anybody else. 2. Moral Judgment Moral judgment is deciding which action is right or wrong because you are able to assess how the different lines of actions that you could take will 6 of 38

7 affect other people. 3. Moral Motivation Moral motivation prioritizes moral values over motives such as self gratification, making money, revenge, protecting your reputation or protecting your organization. 4. Moral Character This is the ability to have the perseverance, the toughness, the conviction and the courage to take action to correct something that you know is wrong. This is taking on the duty to report even if you are not required to report. It is truly the essence of professional behavior. This is the standard that we need to achieve. We need to help people understand that it is their responsibility to stop actions that might be negative for the people that they treat and for the community that we serve. 5. Moral Failure Moral failure occurs when any of these components do not happen. In order to take moral action, you have to have all four of them. It is a complex interaction. Now that we understand all of the terminology and basic theories, we come down to a more important question. There are so many theories and rules HOW do I go about making the right ethical decision in my every day practice??? The Ethical Decision-Making Process: When making ethical decisions, we need to remember the 6 Ethical principles, as they could and SHOULD direct our decisions. (1) Autonomy: patients have the right to make some decisions as well as we do. (2) Beneficence: providing care in the best interest of the patient (3) Confidentiality: respecting an individual s right to privacy (4) Non malfeasance: do no harm (5) Justice: equity or fair treatment (6) Veracity: truthfulness 7 of 38

8 It is also important that an individual be able to answer the following questions. (1) Test for Right versus Wrong- is it obvious? (2) Legal test: Is it legal? (3) PU test: Does it smell or feel wrong-a test of common sense/conscience (4) Front page test: How would it look on the front page of the newspaper? Would that make you change your decision or how you feel about the situation? (5) Mom/Dad Test: How would your parents feel if they knew what you were doing? (6) The professional ethics test: What do the Code of Ethics, Standards of Ethical Conduct say? Know your practice act and rules and regulations. Be active in your professional organization. Realize that at times, rules and regulations change! Make sure you stay updated at all times. So what do our national and state organizations have to say about ethics?? The American Physical Therapy Association (APTA) has very clear guidelines on ethical practice. It is a great tool for clinicians to use when making judgments concerning ethical distresses or dilemmas. 8 of 38

9 EFFECTIVE JULY 1, For more information, go to CODE OF ETHICS HOD S [Amended HOD S ; HOD ; HOD ; HOD ; HOD ; HOD ; HOD ; HOD ; Initial HOD ] [Standard] AMERICAN PHYSICAL THERAPY ASSOCIATION CODE OF ETHICS 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/client 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. No code of ethics is exhaustive nor can it address every situation. Physical therapists are encouraged to seek additional advice or consultation in instances where the guidance of the Code of Ethics may not be definitive. This Code of Ethics is built upon the five roles of the physical therapist (management of patients/clients, consultation, education, research, and administration), the core values of the profession, and the multiple realms of ethical action (individual, organizational, and societal). Physical therapist 9 of 38

10 practice is guided by a set of seven core values: accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility. Throughout the document the primary core values that support specific principles are indicated in parentheses. Unless a specific role is indicated in the principle, the duties and obligations being delineated pertain to the five roles of the physical therapist. Fundamental to the Code of Ethics is the special obligation of physical therapists to empower, educate, and enable those with impairments, activity limitations, participation restrictions, and disabilities to facilitate greater independence, health, wellness, and enhanced quality of life. Revised APTA Code of Ethics and Standards of Ethical Conduct for the Physical Therapist Assistant Principles: Principle #1: Physical therapists shall respect the inherent dignity and rights of all individuals. (Core Values: Compassion, Integrity) 1A. Physical therapists shall act in a respectful manner toward each person regardless of age, gender, race, nationality, religion, ethnicity, social or economic status, sexual orientation, health condition, or disability. 1B. Physical therapists shall recognize their personal biases and shall not discriminate against others in physical therapist practice, consultation, education, research, and administration. Principle #2: Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients/clients. (Core Values: Altruism, Compassion, Professional Duty) 2A. Physical therapists shall adhere to the core values of the profession and shall act in the best interests of patients/clients over the interests of the physical therapist. 2B. Physical therapists shall provide physical therapy services with compassionate and caring behaviors that incorporate the individual and cultural differences of patients/clients. 10 of 38

11 2C. Physical therapists shall provide the information necessary to allow patients or their surrogates to make informed decisions about physical therapy care or participation in clinical research. 2D. Physical therapists shall collaborate with patients/clients to empower them in decisions about their health care. 2E. Physical therapists shall protect confidential patient/client information and may disclose confidential information to appropriate authorities only when allowed or as required by law. Principle #3: Physical therapists shall be accountable for making sound professional judgments. (Core Values: Excellence, Integrity) 3A. Physical therapists shall demonstrate independent and objective professional judgment in the patient s/client s best interest in all practice settings. 3B. Physical therapists shall demonstrate professional judgment informed by professional standards, evidence (including current literature and established best practice), practitioner experience, and patient/client values. 3C. Physical therapists shall make judgments within their scope of practice and level of expertise and shall communicate with, collaborate with, or refer to peers or other health care professionals when necessary. 3D. Physical therapists shall not engage in conflicts of interest that interfere with professional judgment. 3E. Physical therapists shall provide appropriate direction of and communication with physical therapist assistants and support personnel. Principle #4: Physical therapists shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, research participants, other health care providers, employers, payers, and the public. (Core Value: Integrity) 4A. Physical therapists shall provide truthful, accurate, and relevant information and shall not make misleading representations. 11 of 38

12 4B. Physical therapists shall not exploit persons over whom they have supervisory, evaluative or other authority (eg, patients/clients, students, supervisees, research participants, or employees). 4C. Physical therapists shall discourage misconduct by health care professionals and report illegal or unethical acts to the relevant authority, when appropriate. 4D. Physical therapists shall report suspected cases of abuse involving children or vulnerable adults to the appropriate authority, subject to law. 4E. Physical therapists shall not engage in any sexual relationship with any of their patients/clients, supervisees, or students. 4F. Physical therapists shall not harass anyone verbally, physically, emotionally, or sexually. Principle #5: Physical therapists shall fulfill their legal and professional obligations. (Core Values: Professional Duty, Accountability) 5A. Physical therapists shall comply with applicable local, state, and federal laws and regulations. 5B. Physical therapists shall have primary responsibility for supervision of physical therapist assistants and support personnel. 5C. Physical therapists involved in research shall abide by accepted standards governing protection of research participants. 5D. Physical therapists shall encourage colleagues with physical, psychological, or substance related impairments that may adversely impact their professional responsibilities to seek assistance or counsel. 5E. Physical therapists who have knowledge that a colleague is unable to perform their professional responsibilities with reasonable skill and safety shall report this information to the appropriate authority. 5F. Physical therapists shall provide notice and information about alternatives for obtaining care in the event the physical therapist terminates the provider relationship while the patient/client continues to need physical therapy services. 12 of 38

13 Principle #6: Physical therapists shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and professional behaviors. (Core Value: Excellence) 6A. Physical therapists shall achieve and maintain professional competence. 6B. Physical therapists shall take responsibility for their professional development based on critical self-assessment and reflection on changes in physical therapist practice, education, health care delivery, and technology. 6C. Physical therapists shall evaluate the strength of evidence and applicability of content presented during professional development activities before integrating the content or techniques into practice. 6D. Physical therapists shall cultivate practice environments that support professional development, lifelong learning, and excellence. Principle #7: Physical therapists shall promote organizational behaviors and business practices that benefit patients/clients and society. (Core Values: Integrity, Accountability) 7A. Physical therapists shall promote practice environments that support autonomous and accountable professional judgments. 7B. Physical therapists shall seek remuneration as is deserved and reasonable for physical therapist services. 7C. Physical therapists shall not accept gifts or other considerations that influence or give an appearance of influencing their professional judgment. 7D. Physical therapists shall fully disclose any financial interest they have in products or services that they recommend to patients/clients. 7E. Physical therapists shall be aware of charges and shall ensure that documentation and coding for physical therapy services accurately reflect the nature and extent of the services provided. 7F. Physical therapists shall refrain from employment arrangements, or other arrangements, that prevent physical therapists from fulfilling professional obligations to patients/clients. 13 of 38

14 Principle #8: Physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally. (Core Values: Social Responsibility) 8A. Physical therapists shall provide pro bono physical therapy services or support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured. 8B. Physical therapists shall advocate to reduce health disparities and health care inequities, improve access to health care services, and address the health, wellness, and preventive health care needs of people. 8C. Physical therapists shall be responsible stewards of health care resources and shall avoid over-utilization or under-utilization of physical therapy services. 8D. Physical therapists shall educate members of the public about the benefits of physical therapy and the unique role of the physical therapist. STANDARDS OF ETHICAL CONDUCT FOR THE PHYSICAL THERAPIST ASSISTANT HOD S [Amended HOD S ; HOD ; Initial HOD ] [Standard] Standards of Ethical Conduct for the Physical Therapist Assistant Preamble The Standards of Ethical Conduct for the Physical Therapist Assistant (Standards of Ethical Conduct) delineate the ethical obligations of all physical therapist assistants as determined by the House of Delegates of the American Physical Therapy Association (APTA). The Standards of Ethical Conduct provide a foundation for conduct to which all physical therapist assistants shall adhere. Fundamental to the Standards of Ethical Conduct is the special obligation of physical therapist assistants to enable patients/clients to achieve greater independence, health and wellness, and enhanced quality of life. No document that delineates ethical standards can address every situation. Physical therapist assistants are encouraged to seek additional advice or consultation in instances where the guidance of the Standards of Ethical Conduct may not be definitive. 14 of 38

15 Standards: Standard #1: Physical therapist assistants shall respect the inherent dignity, and rights, of all individuals. 1A. Physical therapist assistants shall act in a respectful manner toward each person regardless of age, gender, race, nationality, religion, ethnicity, social or economic status, sexual orientation, health condition, or disability. 1B. Physical therapist assistants shall recognize their personal biases and shall not discriminate against others in the provision of physical therapy services. Standard #2: Physical therapist assistants shall be trustworthy and compassionate in addressing the rights and needs of patients/clients. 2A. Physical therapist assistants shall act in the best interests of patients/clients over the interests of the physical therapist assistant. 2B. Physical therapist assistants shall provide physical therapy interventions with compassionate and caring behaviors that incorporate the individual and cultural differences of patients/clients. 2C. Physical therapist assistants shall provide patients/clients with information regarding the interventions they provide. 2D. Physical therapist assistants shall protect confidential patient/client information and, in collaboration with the physical therapist, may disclose confidential information to appropriate authorities only when allowed or as required by law. Standard #3: Physical therapist assistants shall make sound decisions in collaboration with the physical therapist and within the boundaries established by laws and regulations. 3A. Physical therapist assistants shall make objective decisions in the patient s/client s best interest in all practice settings. 3B. Physical therapist assistants shall be guided by information about best practice regarding physical therapy interventions. 3C. Physical therapist assistants shall make decisions based upon their level of competence and consistent with patient/client values. 15 of 38

16 3D. Physical therapist assistants shall not engage in conflicts of interest that interfere with making sound decisions. 3E. Physical therapist assistants shall provide physical therapy services under the direction and supervision of a physical therapist and shall communicate with the physical therapist when patient/client status requires modifications to the established plan of care. Standard #4: Physical therapist assistants shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, other health care providers, employers, payers, and the public. 4A. Physical therapist assistants shall provide truthful, accurate, and relevant information and shall not make misleading representations. 4B. Physical therapist assistants shall not exploit persons over whom they have supervisory, evaluative or other authority (eg, patients/clients, students, supervisees, research participants, or employees). 4C. Physical therapist assistants shall discourage misconduct by health care professionals and report illegal or unethical acts to the relevant authority, when appropriate. 4D. Physical therapist assistants shall report suspected cases of abuse involving children or vulnerable adults to the supervising physical therapist and the appropriate authority, subject to law. 4E. Physical therapist assistants shall not engage in any sexual relationship with any of their patients/clients, supervisees, or students. 4F. Physical therapist assistants shall not harass anyone verbally, physically, emotionally, or sexually. Standard #5: Physical therapist assistants shall fulfill their legal and ethical obligations. 5A. Physical therapist assistants shall comply with applicable local, state, and federal laws and regulations. 16 of 38

17 5B. Physical therapist assistants shall support the supervisory role of the physical therapist to ensure quality care and promote patient/client safety. 5C. Physical therapist assistants involved in research shall abide by accepted standards governing protection of research participants. 5D. Physical therapist assistants shall encourage colleagues with physical, psychological, or substance related impairments that may adversely impact their professional responsibilities to seek assistance or counsel. 5E. Physical therapist assistants who have knowledge that a colleague is unable to perform their professional responsibilities with reasonable skill and safety shall report this information to the appropriate authority. Standard #6: Physical therapist assistants shall enhance their competence through the lifelong acquisition and refinement of knowledge, skills, and abilities. 6A. Physical therapist assistants shall achieve and maintain clinical competence. 6B. Physical therapist assistants shall engage in lifelong learning consistent with changes in their roles and responsibilities and advances in the practice of physical therapy. 6C. Physical therapist assistants shall support practice environments that support career development and lifelong learning. Standard #7: Physical therapist assistants shall support organizational behaviors and business practices that benefit patients/clients and society. 7A. Physical therapist assistants shall promote work environments that support ethical and accountable decision-making. 7B. Physical therapist assistants shall not accept gifts or other considerations that influence or give an appearance of influencing their decisions. 7C. Physical therapist assistants shall fully disclose any financial interest they have in products or services that they recommend to patients/clients. 7D. Physical therapist assistants shall ensure that documentation for their interventions accurately reflects the nature and extent of the services provided. 17 of 38

18 7E. Physical therapist assistants shall refrain from employment arrangements, or other arrangements, that prevent physical therapist assistants from fulfilling ethical obligations to patients/clients. Standard #8: Physical therapist assistants shall participate in efforts to meet the health needs of people locally, nationally, or globally. 8A. Physical therapist assistants shall support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured. 8B. Physical therapist assistants shall advocate for people with impairments, activity limitations, participation restrictions, and disabilities in order to promote their participation in community and society. 8C. Physical therapist assistants shall be responsible stewards of health care resources by collaborating with physical therapists in order to avoid overutilization or under-utilization of physical therapy services. 8D. Physical therapist assistants shall educate members of the public about the benefits of physical therapy. APTA Guide for Professional Conduct Purpose This Guide for Professional Conduct (Guide) is intended to serve physical therapists in interpreting the Code of Ethics for the Physical Therapist (Code) of the American Physical Therapy Association (APTA) in matters of professional conduct. The APTA House of Delegates in June of 2009 adopted a revised Code, which became effective on July 1, The Guide provides a framework by which physical therapists may determine the propriety of their conduct. It is also intended to guide the professional development of physical therapist students. The Code and the Guide apply to all physical therapists. These guidelines are subject to change as the dynamics of the profession change and as new patterns of health care delivery are developed and accepted by the professional community and the public. 18 of 38

19 Interpreting Ethical Principles The interpretations expressed in this Guide reflect the opinions, decisions, and advice of the Ethics and Judicial Committee (EJC). The interpretations are set forth according to topic. These interpretations are intended to assist a physical therapist in applying general ethical principles to specific situations. They address some but not all topics addressed in the Principles and should not be considered inclusive of all situations that could evolve. This Guide is subject to change, and the Ethics and Judicial Committee will monitor and timely revise the Guide to address additional topics and Principles when necessary and as needed. The Preamble states as follows: Preamble to the Code 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/client 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. No code of ethics is exhaustive nor can it address every situation. Physical therapists are encouraged to seek additional advice or consultation in instances where the guidance of the Code of Ethics may not be definitive. 19 of 38

20 This Code of Ethics is built upon the five roles of the physical therapist (management of patients/clients, consultation, education, research, and administration), the core values of the profession, and the multiple realms of ethical action (individual, organizational, and societal). Physical therapist practice is guided by a set of seven core values: accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility. Throughout the document the primary core values that support specific principles are indicated in parentheses. Unless a specific role is indicated in the principle, the duties and obligations being delineated pertain to the five roles of the physical therapist. Fundamental to the Code of Ethics is the special obligation of physical therapists to empower, educate, and enable those with impairments, activity limitations, participation restrictions, and disabilities to facilitate greater independence, health, wellness, and enhanced quality of life. Interpretation: Upon the Code of Ethics for the Physical Therapist being amended effective July 1, 2010, all the lettered principles in the Code contain the word shall and are mandatory ethical obligations. The language contained in the Code is intended to better explain and further clarify existing ethical obligations. These ethical obligations predate the revised Code. Although various words have changed, many of the obligations are the same. Consequently, the addition of the word shall serves to reinforce and clarify existing ethical obligations. A significant reason that the Code was revised was to provide physical therapists with a document that was clear enough such that they can read it standing alone without the need to seek extensive additional interpretation. The Preamble states that no Code of Ethics is exhaustive nor can it address every situation. The Preamble also states that physical therapists are encouraged to seek additional advice or consultation in instances in which the guidance of the Code may not be definitive. Potential sources for advice and counsel include third parties and the myriad resources available on the APTA Web site. Inherent in a physical therapist s ethical decision-making process is the examination of his or her unique set of facts relative to the Code. 20 of 38

21 Topics Respect Principle 1A states as follows: 1A. Physical therapists shall act in a respectful manner toward each person regardless of age, gender, race, nationality, religion, ethnicity, social or economic status, sexual orientation, health condition, or disability. Interpretation: Principle 1A addresses the display of respect toward others. Unfortunately, there is no universal consensus about what respect looks like in every situation. For example, direct eye contact is viewed as respectful and courteous in some cultures and inappropriate in others. It is up to the individual to assess the appropriateness of behavior in various situations. Altruism Principle 2A states as follows: 2A. Physical therapists shall adhere to the core values of the profession and shall act in the best interests of patients/clients over the interests of the physical therapist. Interpretation: Principle 2A reminds physical therapists to adhere to the profession s core values and act in the best interest of patients/clients over the interests of the physical therapist. Often this is done without thought, but sometimes, especially at the end of the day when the physical therapist is fatigued and ready to go home, it is a conscious decision. For example, the physical therapist may need to make a decision between leaving on time and staying at work longer to see a patient who was 15 minutes late for an appointment. Patient Autonomy Principle 2C states as follows: 2C. Physical therapists shall provide the information necessary to allow patients or their surrogates to make informed decisions about physical therapy care or participation in clinical research. Interpretation: The underlying purpose of Principle 2C is to require a physical therapist to respect patient autonomy. In order to do so, a physical 21 of 38

22 therapist shall communicate to the patient/client the findings of his/her examination, evaluation, diagnosis, and prognosis. A physical therapist shall use sound professional judgment in informing the patient/client of any substantial risks of the recommended examination and intervention and shall collaborate with the patient/client to establish the goals of treatment and the plan of care. Ultimately, a physical therapist shall respect the patient s/client s right to make decisions regarding the recommended plan of care, including consent, modification, or refusal. Professional Judgment Principles 3, 3A, and 3B state as follows: 3: Physical therapists shall be accountable for making sound professional judgments. (Core Values: Excellence, Integrity) 3A. Physical therapists shall demonstrate independent and objective professional judgment in the patient s/client s best interest in all practice settings. 3B. Physical therapists shall demonstrate professional judgment informed by professional standards, evidence (including current literature and established best practice), practitioner experience, and patient/client values. Interpretation: Principles 3, 3A, and 3B state that it is the physical therapist s obligation to exercise sound professional judgment, based upon his/her knowledge, skill, training, and experience. Principle 3B further describes the physical therapist s judgment as being informed by three elements of evidence-based practice. With regard to the patient/client management role, once a physical therapist accepts an individual for physical therapy services he/she shall be responsible for: the examination, evaluation, and diagnosis of that individual; the prognosis and intervention; reexamination and modification of the plan of care; and the maintenance of adequate records, including progress reports. A physical therapist shall establish the plan of care and shall provide and/or supervise and direct the appropriate interventions. Regardless of practice setting, a physical therapist has primary responsibility for the physical therapy care of a patient and shall make independent judgments regarding that care consistent with accepted professional standards. If the diagnostic process reveals findings that are outside the scope of the physical therapist's knowledge, experience, or expertise or that indicate the need for care outside the scope of physical therapy, the physical therapist shall so inform the patient/client and shall refer the patient/client to an appropriate practitioner. A physical therapist 22 of 38

23 shall determine when a patient/client will no longer benefit from physical therapy services. When a physical therapist's judgment is that a patient will receive negligible benefit from physical therapy services, the physical therapist shall not provide or continue to provide such services if the primary reason for doing so is to further the financial self-interest of the physical therapist or his/her employer. A physical therapist shall avoid overutilization of physical therapy services. See Principle 8C. Supervision Principle 3E states as follows: 3E. Physical therapists shall provide appropriate direction of and communication with physical therapist assistants and support personnel. Interpretation: Principle 3E describes an additional circumstance in which sound professional judgment is required; namely, through the appropriate direction of and communication with physical therapist assistants and support personnel. Further information on supervision via applicable local, state, and federal laws and regulations (including state practice acts and administrative codes) is available. Information on supervision via APTA policies and resources is also available on the APTA Web site. See Principles 5A and 5B. Integrity in Relationships Principle 4 states as follows: 4: Physical therapists shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, research participants, other health care providers, employers, payers, and the public. (Core Value: Integrity) Interpretation: Principle 4 addresses the need for integrity in relationships. This is not limited to relationships with patients/clients, but includes everyone physical therapists come into contact with professionally. For example, demonstrating integrity could encompass working collaboratively with the health care team and taking responsibility for one s role as a member of that team. 23 of 38

24 Reporting Principle 4C states as follows: 4C. Physical therapists shall discourage misconduct by healthcare professionals and report illegal or unethical acts to the relevant authority, when appropriate. Interpretation: When considering the application of when appropriate under Principle 4C, keep in mind that not all allegedly illegal or unethical acts should be reported immediately to an agency/authority. The determination of when to do so depends upon each situation s unique set of facts, applicable laws, regulations, and policies. Depending upon those facts, it might be appropriate to communicate with the individuals involved. Consider whether the action has been corrected, and in that case, not reporting may be the most appropriate action. Note, however, that when an agency/authority does examine a potential ethical issue, fact finding will be its first step. The determination of ethicality requires an understanding of all of the relevant facts, but may still be subject to interpretation. The EJC Opinion titled: Topic: Preserving Confidences; Physical Therapist's Reporting Obligation With Respect to Unethical, Incompetent, or Illegal Acts provides further information on the complexities of reporting. Exploitation Principle 4E states as follows: 4E. Physical therapists shall not engage in any sexual relationship with any of their patient/clients, supervisees or students. Interpretation: The statement is fairly clear sexual relationships with their patients/clients, supervisees or students are prohibited. This component of Principle 4 is consistent with Principle 4B, which states: Physical therapists shall not exploit persons over whom they have supervisory, evaluative or other authority (e.g. patients/clients, students, supervisees, research participants, or employees). Next, consider this excerpt from the EJC Opinion titled Topic: Sexual Relationships with Patients/Former Patients: A physical therapist stands in a relationship of trust to each patient and has an ethical obligation to act in the patient's best interest and to avoid any exploitation or abuse of the patient. Thus, if a physical therapist has natural feelings of attraction toward a patient, he/she must sublimate those feelings in order to avoid sexual exploitation of the patient. One s ethical decision making process should focus on whether the patient/client, supervisee or student is being exploited. In this context, 24 of 38

25 questions have been asked about whether one can have a sexual relationship once the patient/client relationship ends. To this question, the EJC has opined as follows: The Committee does not believe it feasible to establish any bright-line rule for when, if ever, initiation of a romantic/sexual relationship with a former patient would be ethically permissible. The Committee imagines that in some cases a romantic/sexual relationship would not offend... if initiated with a former patient soon after the termination of treatment, while in others such a relationship might never be appropriate. Colleague Impairment Principle 5D and 5E state as follows: 5D. Physical therapists shall encourage colleagues with physical, psychological, or substance-related impairments that may adversely impact their professional responsibilities to seek assistance or counsel. 5E. Physical therapists who have knowledge that a colleague is unable to perform their professional responsibilities with reasonable skill and safety shall report the information to the appropriate authority. Interpretation: The central tenet of Principles 5D and 5E is that inaction is not an option for a physical therapist when faced with the circumstances described. Principle 5D states that a physical therapist shall encourage colleagues to seek assistance or counsel while Principle 5E addresses reporting information to the appropriate authority. 5D and 5E both require a factual determination on your part. This may be challenging in the sense that you might not know or it might be difficult for you to determine whether someone in fact has a physical, psychological, or substance-related impairment. In addition, it might be difficult to determine whether such impairment may be adversely affecting his or her professional responsibilities. Moreover, once you do make these determinations, the obligation under 5D centers not on reporting, but on encouraging the colleague to seek assistance. However, the obligation under 5E does focus on reporting. But note that 5E discusses reporting when a colleague is unable to perform, whereas 5D discusses encouraging colleagues to seek assistance when the impairment may adversely affect his or her professional responsibilities. So, 5D discusses something that may be affecting performance, whereas 5E addresses a situation in which someone is clearly unable to perform. The 2 situations are distinct. In addition, it is important to note that 5E does not mandate to whom you report; it gives you discretion to determine the appropriate authority. The EJC Opinion titled: Topic: Preserving Confidences; Physical Therapist's Reporting Obligation 25 of 38

26 With Respect to Unethical, Incompetent, or Illegal Acts provides further information on the complexities of reporting. Professional Competence Principle 6A states as follows: 6A. Physical therapists shall achieve and maintain professional competence. Interpretation: 6A requires a physical therapist to maintain professional competence within one s scope of practice throughout one s career. Maintaining competence is an ongoing process of self-assessment, identification of strengths and weaknesses, acquisition of knowledge and skills based on that assessment, and reflection on and reassessment of performance, knowledge and skills. Numerous factors including practice setting, types of patients/clients, personal interests and the addition of new evidence to practice will influence the depth and breadth of professional competence in a given area of practice. Additional resources on Continuing Competence are available on the APTA Web site. Professional Growth Principle 6D states as follows: 6D. Physical therapists shall cultivate practice environments that support professional development, life-long learning, and excellence. Interpretation: 6D elaborates on the physical therapist s obligations to foster an environment conducive to professional growth, even when not supported by the organization. The essential idea is that this is the physical therapist s responsibility, whether or not the employer provides support. Charges and Coding Principle 7E states as follows: 7E. Physical therapists shall be aware of charges and shall ensure that documentation and coding for physical therapy services accurately reflect the nature and extent of the services provided. Interpretation: Principle 7E provides that the physical therapist must make sure that the process of documentation and coding accurately captures the charges for services performed. In this context, where charges cannot be 26 of 38