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PTRS 701: Professionalism Ethics Collaboration by Ally Majercik, Alexa Heier, Amanda Gion, Phil Schmitz, & Ali Pistora Four Foundational Concepts according to the APTA Autonomy 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 Concepts according to the APTA Autonomy Beneficence 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 Concepts according to the APTA Autonomy Beneficence Non-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 Concepts according to the APTA Autonomy Beneficence Non-Maleficence Justice • 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 Individual Process Moral Sensitivity Organizational Jack Glaser, 1970’s & Managed Care Societal Situation Issue/Problem Dilemma Moral Judgment Moral Motivation Distress Temptation Silence Moral Courage MORAL TEMPTATION DILEMMA (RIGHT VS RIGHT) (RIGHT VS WRONG) define ethic issues reflect MORAL COURAGE decide the right choice implement, evaluate, re-assess Rosemary Barnitt (1998) Top UK Physical Therapy Dilemmas 1. Unfair Allocation or Lack of Resources -priority in treating those with insurance - discharging policies regardless of patient readiness • 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-4945-80EF4D946A78F862. 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.
