USA: Psychosocial & Ethical Aspects of PT – Flashcards

Fundamentalist: Strict adherences to the rules and regulations Relativist: Considers unique circumstances that may be involved such as religion, gender, culture Deductive Rationalist: Considers all possible aspects that can be involved including all rules and regulations and unique circumstances RIPS

Fundamentalist

Relativist

Deductive Rationalist:

The Code of Ethics for the Physical Therapist delineates the ethical obligations of all physical therapists as determined by the House of Delegates of the American Physical Therapy Association (APTA). Purpose: 1.Define the ethical principles that form the foundation of physical therapist practice in patient/client management, consultation, eduation, 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

Accountability Altruism Compassion/Caring Excellence Integrity Professional Duty Social Responsibility

The discipline dealing with what is good/bad and with moral duties and obligations. A set of moral principles or values. A theory or system of moral values. The principles of conduct governing an individual or a group (professionals).

*Personal Priorities. - Family and personal life. - Greed. - Sense of entitlement (flaunting of standards). *Poor self confidence of self-esteem. *Failure to assume responsibility for our actions (externalization). Impairment (illness, fatigue, depression, substance abuse). *Pressure from others (real or perceived). *Poor respect for appropriate boundaries.

As a child: Share everything. Play fair. Don't take things that aren't yours. Hold hands and stick together. Be aware of wonder. Live a balanced life. Take a nap every afternoon.

Ethical issues have an organizational and social dimension. Clinical frameworks/algorithms are useful for diagnosis. A framework can help to classify (diagnose) ethical situations.

The Realm-Individual Process-Situation (RIPS) Model of Ethical Decision-Making

Individual Organizational/Institutional Societal Each realm deals with trying to promote good - issues of right/wrong. They differ on definitions, priorities, authority.

Moral sensitivity Moral judgment Moral motivation Moral courage

Issue or problem Dilemma Distress Temptation Silence

Primary concern is the individual - the good of the client or patient. Focus is lower complexity of problems involving rights duties, relationships, and behaviors between individuals

Primary concern is the good of the organization. Examples are mediating structures, organizations, families, agencies, corporations. Focus - Structures and systems that will facilitate organizational or institutional goals Conflicts in this area might be billing issues, productivity quotas etc., any institutional policy that dictates or interferes with your treatment procedures.

Primary concern is the common good. Examples include national and state systems and structures - legal, financial, cultural, religious Focus- higher complexity and importance of problems and issues A lot of physical therapists are reluctant to tackle these global types of issues. Examples of physical therapist involvement includes things like writing letters to elected officials, going to Legislative day, etc.

The primary skill in making good moral decisions:sensitivity to the moral issues involved in ADL's. Quite often we may act in a morally questionable manner just because we were insensitive to the moral nature of the situation. Often, making the right decision requires a real sensitivity to the moral dimension of a situation, as well as to the range of interests involved. Sometimes, due to the technical nature of a problem, we fail to recognize that it also has a moral dimension. We may think that the decision can be made based on purely technical criteria, and therefore we may be blind to the moral significance of the situation. The decision of which medicine to prescribe for a particular condition, for example, involves making not just a technical decision about efficacy, but also a value judgment concerning the relative acceptability of various side effects and various risks.

requires deciding on right versus wrong actions Moral judgments are expressions of or about your own attitudes. Individuals make moral judgments in their own way guided by our own moral convictions and conscience.

involves implementing the chosen ethical action, including the development of a plan and perseverance in the face of barriers and adversity Moral courage is the ability to put ethics into action. It means standing up and standing out in defense of principle, even when others are standing aside. Ethical action is more than whistle blowing. It involves daily acts of integrity, carried out with dignity, in which individuals stand up for what is right and encourage others to do the same.

Important values are being challenged

Two alternative courses of action may be taken, both of which fulfill an important duty, and it is not possible to fulfill both obligations

You know the right course of action, but are not authorized or empowered to perform it.

Involves a choice between a right and a wrong in which you may stand to benefit from doing the wrong thing.

Ethical values are challenged, but no one is speaking about this challenge to values.

Step 1 - Recognize and define the ethical issues Step 2 - Reflect Step 3 - Decide the Right Thing to Do Step 4 - Implement, Evaluate, Re-assess

Is this really an ethical situation? Determine the realm, the individual process and the situation.

Legal Test: Is it something illegal? Stench Test: Does something feel wrong (gut reaction)? Front page Test: How would you like this on the front page of the newspaper? Mom Test: If I were my parent, would I do this?

Rule Based - follow the rules, ethical principles Ends Based - determine outcomes for alternative actions and resulting good or harm Care-Based - decision based on relationships and concern for others

Implement, Evaluate, Re-assess

Step 2 in RIPS

Anti-Trust/Monopoly:Since insurance companies only require a physician referral for payment, then doctors self-referring will present an unfair advantage to the local physical therapist in private practice across the street Like Professional Ownership:Several professions (attorneys, CPAs, etc.) have legally limited ownership of their profession to 'only' members of that particular profession. Conflict of Interest/Over utilization: Quality of Care: The strong implication is that physician based physical therapists have compromised their ethical standards, their clinical knowledge base and commitment to excellence. Ethical Dilemma: Since the physical therapists are paid by the medical doctors, then if the medical doctor wants more visits for a patient than the physical therapist deems necessary, the treating therapist will compromise their legal obligations of patient discharge, leading to unethical over-utilization due to fear of unemployment.

1. Treating fellow employees presents a conflict of interest - NOT IF the physical therapist retains the ability to make independent clinical decisions. If that is preserved then the therapist can provide care that is in the best interests of the patient, and is in accordance with the Code of Ethics. The only situation where this might be compromised is if the therapist providing the care is also the injured employee's supervisor, or has other employment "authority" over the individual. That situation should be avoided, as it does present a potential conflict. 2. There is concern about the ability to ensure the privacy/confidentiality-as long as you adhere to well-accepted standards and specific laws regarding the release and disclosure of medical information, then you would not be in conflict with this Principle. Often by law, employers are allowed some degree of information about an employee's injury so they can appropriately manage their personnel.

shall not engage in any sexual relationship or activity, whether consensual or nonconsensual, with any patient while a physical therapist/patient relationship exists." Patients must be considered vulnerable within this patient/therapist relationship due to their level of trust in the therapist and the power differential inherent in the relationship. A relationship of trust is formed and the PT has an ethical obligation to act in the patient's best interest and to avoid any exploitation or abuse of the patient. If the PT has natural feelings of attraction toward a patient, he/she must sublimate those feelings in order to avoid sexual exploitation of the patient. **The APTA's Code emphasizes that a physical therapist has a responsibility to put the patient's interests first and to avoid exploitation of the patient's vulnerability.

*Is the age difference between the physical therapist and the former patient substantial? *Is the patient considerably poorer or less well educated than the physical therapist? *Does the patient have major psychiatric or psychological problems? Does he/she have problems of substance abuse? *Has the patient been the victim of abuse, especially sexual abuse? *Is the patient particularly lonely or extremely shy? *Is the patient suffering from a separation or divorce, death of a loved one, or economic difficulties?

The Committee does not believe that resort to any arbitrary period of time can answer the question. The determination whether the physical therapist is/would be using/exploiting trust, knowledge, and/or influence derived from the therapeutic relationship depends on circumstances unique to the particular case. The key factors relate to the patient and the character of the relationship during physical therapy, not the mere chronological distance from the last treatment session.

The Committee does not believe that it makes sense for it to speak of the ethical obligations of physical therapy aides, but only to comment on the ethical responsibilities of physical therapists (and physical therapist assistants) that may relate to the presence and activities of aides in a clinic. The Committee is reluctant to say that a PT has an ethical obligation to institute a policy prohibiting an aide from having a sexual relationship with a patient. NOT DIRECT STANDARD FOR TECH BUT SUPERVISORY ROLE FOR TREATING PT: "supervising physical therapist has primary responsibility for the physical therapy care rendered to a patient/client," This statement implies that the physical therapist is responsible for taking reasonable measures to ensure that support personnel do not act in a way injurious to patients.

(1) 4D. Physical therapists shall report suspected cases of abuse involving children or vulnerable adults to the appropriate authority, subject to law. (2) 5A. Physical therapists shall comply with applicable local, state, and federal laws and regulations. (3) 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 (2) The law requires any person who believes that a child, or person 65 years or older, or an adult with disabilities is being abused, neglected, or exploited to report the circumstances to Dept of Family Protective Services (or equivalent).

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. 3E PTs shall provide appropriate direction of and commnication with PTAs and support personnel. 5E PT 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 authorities

Medicare states only a PT can bill for treatment. They can do unbilled treatment but is it ethical that an unlicensed worker is providing treatment?

NO!

The supervising PT Principle #5: Physical therapists shall fulfill their legal and professional obligations. 5B. Physical therapists shall have primary responsibility for supervision of physical therapist assistants and support personnel.