Ethical Decision-Making in Physical Therapy

  By Susan McPhail Wittjen, PT, PhD

CASE 7

You have been asked to begin gait training on a 28-year-old woman who was brought into the emergency room yesterday morning after a car accident. She had a concussion, facial lacerations, and a severely fractured tibia. She underwent surgery last night and is just now becoming alert enough to begin activities to prepare her for ambulation. The nurse has told you that her 4-year-old daughter was killed in the accident, but that the decision was made not to tell her about her daughter's death "for her own good" until she is more medically stable. As you begin your treatment with the patient, she asks you directly to tell her how her daughter is doing.

What would you say?

What are your alternatives and what are the consequences of each of them?

What are your duties as a physical therapist, as a human being, as an employee?

In this case your dilemma is what you should say to the patient. You would identify the alternatives first. Here are four that come to mind. You may be able to think of others. 

1) You could tell her the truth. 

2) You could lie to her and say that her daughter is fine. 

3) You could say you don't know (is that a lie?). 

4) You could try to find someone to talk to her.

Next identify the consequences of each alternative. 

1.  If you tell her the truth about her daughter, not only will you cause trouble in the hospital for going against the "agreed upon" course of action, you may not be competent to discuss these types of issues with patients. 
2. If you have a strong sense that you should always tell the truth, this may be impossible for you. It also may cause damage in the long run to the patient. 
3. If you say you don't know and you think that this is a lie, you may not be able to do it. This may have neutral consequences unless the patient insists on you finding out for her. 
4. If you tell the patient that you will find someone to talk to her, you may have a difficult time finding someone who will comply with your request.

Choose the alternative with the best possible consequences for everyone. You can see that there is not always a "right" choice and sometimes the choices are not always positive. This is an example of a case in which some mental preparation prior to entering the patient's room would have been helpful. As you can see, you would need much more information to make a decision in this case, but in hospital settings we often don't have or take the time to find out all of the necessary information. Although you should decide for yourself, you may want to consider that when someone tells you that you should not tell a patient something, you may want to reconsider doing a treatment until certain issues are settled.

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