Transcript PTRS 701 Ethics

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
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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.