PTRS 701: Professionalism

Ethics

Collaboration by Ally Majercik, Alexa Heier, Amanda Gion, Phil Schmitz, & Ali Pistora

Four Foundational Conceptsaccording to the APTA

AutonomyAutonomy Beneficence Non-Maleficence Justice• The right of self-determination• Applies to PT’s having authority to make decisions

regarding course of treatment AND patients making decisions about their own care

• Patients must be truthfully informed about their condition and the potential risks and benefits of treatment

• “Physical therapists must recognize that professional autonomy represents a social contract based on public trust and service to meet the health needs of people who are experiencing disablement in order to maintain their individual autonomy.”

Four Foundational Conceptsaccording to the APTA

Autonomy BeneficenceBeneficence Non-Maleficence Justice

• Promoting good• Providing care in the best interest of the

patient• Contributing knowledge to end-of-life

discussions– PTs have expertise in quality-of-life

Four Foundational Conceptsaccording to the APTA

Autonomy Beneficence Non-MaleficenceNon-Maleficence Justice

• “Above all, do no harm”• Usually related to making end-of-life decisions• Patient’s wishes and quality of life must be

considered• What’s the benefit of providing continuing

treatment? Is it doing more harm than good?

Four Foundational Conceptsaccording to the APTA

Autonomy Beneficence Non-Maleficence JusticeJustice

• Justice is equity and fairness in treatment• Distributive justice – equal distribution of

healthcare throughout society• Comparative justice – healthcare at the

individual level– age, disability, gender, race, ethnicity, religion– distribution of resources• aging population, increased need for services

What is Justice?

• Concept of what is morally right based on ethics

• Determined by?– Fairness– Need– Entitlement

Types of Justice

• Distributive• Criminal• Compensatory• Procedural

What is Informed Consent?

• Process in which a patient participates in choices about his/her healthcare.

• It is a physical therapist’s duty to respect this right.– Patients can refuse a specific course of action.

Conditions of Informed Consent

• 3 conditions must be met:– Competence of the patient– Information– Voluntariness

Autonomy

• One of the primary foundational concepts of ethics

• Definition: refers to the right to self determination

• Autonomous individuals are going to act purposefully while understanding what they are doing, without having outside influence

Autonomy cont.• This is the primary concept being addressed when

talking about informed consent• A therapist will explain the treatment, reasoning

behind what they are doing, and other options they may have, all while making sure the patient understands the procedures and if there are any risks.

• The therapist has to do all this in a way that will not influence the patient’s decision. The patient must be presented the facts and be able to make an educated decision without bias from the therapist.

Confidentiality

• Definition: duty to maintain privacy of information concerning patients by not divulging it to unauthorized personnel

• This is important in the practice of PT – HIPPA states the guidelines that must be followed by each therapist

• Basically, you can’t use names or anything that could identify a patient

Confidentiality cont.

• Physical therapists shall protect confidential patient/client information and may disclose confidential information to appropriate authorities only when allowed or as required by law.

• Confidentiality vs. privacy:– Always involve a relationship (patient/therapist) in

which information is kept– Privacy does not need a relationship

• i.e.. not sharing the password to your Facebook

Professional Boundaries

• “The idea of not becoming inappropriately involved, emotionally or behaviorally, with patients and other involved in one’s work.” – Gabard and Martin (2003)

• Therapeutic Relationship– Patients Needs go first! The core of therapy

practice– Power, Trust, Respect, Closeness• Violation of any of these 4 values makes therapeutic

relationships hard to maintain.

Yellow Flags for Boundary Crossing • Spending extra time than what is needed for

therapy with patient• Discussing personal problems• Dressing differently on days when you see the

patient• Frequent thoughts about patient outside of

therapy• Providing patient personal information (outside

of the context of therapy)• Getting defensive when asked about the patient

Conflict Of Interest

• When a therapist has an interest that competes with/prevents the professional obligation the therapist holds

• Examples:– Employment– Stock ownership– Paid testimonies– Patient applications– Grants– Gifts

Avoiding Conflict of Interest

• Don’t accept large (in monetary value) gifts• Research employees and companies before

doing business with them• Create a well-structured Code of Ethics• Provide third-party intervention in case

something happens

Realm Individual Process

Situation

Individual

Organizational

Societal

Moral Sensitivity

Moral Judgment

Moral Motivation

Moral Courage

Issue/Problem

Dilemma

Distress

Temptation

Silence

Jack Glaser, 1970’s& Managed Care

define ethic issues

reflect

decide the right choice

implement, evaluate, re-assess

MORAL TEMPTATION

DILEMMA

MORAL COURAGE

(RIGHT VS RIGHT)

(RIGHT VS WRONG)

1. Unfair Allocation or Lack of Resources -priority in treating those with insurance- discharging policies regardless of patient readiness

Rosemary Barnitt (1998) Top UK Physical Therapy Dilemmas

• 2. Treatment Effectiveness– Should treatment be given; how

much treatment given; and what is the evidence for treating effectively? • Examples

– Handicapped children whom make minor progress vs. adults to get back to work

– Patient will clearly pass away, but still carry on therapy

References• Barnitt, R. (1998). Ethical dilemmas in occupational therapy and physical therapy: a survey

of practitioners in the UK national health service. Journal of Medical Ethics, 24, 193-199.• Bryant, B. J. (2012). How to avoid conflict of interest in the workplace. Ehow. Retrieved

from http://www.ehow.com/how_5556695_avoid-conflict-interest-workplace.html.• California: ethical decisions in physical therapy. (2008-2012). Retrieved from

http://atrainceu.com/Courses.php?CourseID=46&page=2• Google images. (2012). Google. Retrieved from www.google.com• Sandstrom, R. (2005). The meanings of autonomy for physical therapy. Journal of the

American Physical Therapy Association. Retrieved from http://ptjournal.apta.org/content/87/1/98.abstract

• Swisher, L. L. (2008). Professionalism: ethic compass [PowerPoint slides]. American Physical Therapy Association. Retrieved from http://learningcenter.apta.org/showCourse.aspx?cs=6F55F3E0-EA7C-4945-80EF-4D946A78F862.

• Swisher, L. L., Arslanian, L. E., & Davis, C. M. (2005). Realm-individual process-situation (RIPS) model of ethical decision-making. Journal of Health Policy & Administration, 5(3), 1-7.

• Where’s the line? [PDF document]. (2009). College of Physical Therapists of BC. Retrieved from http://www.cptbc.org/pdf/Where_is_my_line.pdf.