Law and Ethics
Law and ethics are two separate domains although they often have overlapping concerns. The law may refer to federal, state or other levels of formal rules of conduct that govern the activities of all members of society. All citizens must know and abide by the laws that are passed by our elected representatives, especially those that affect them personally and professionally. Some laws are specific to physical therapists and physical therapist assistants, for example our state practice act that regulates our licensure. The rules that are promulgated by state agencies interpreting the legislatively enacted laws must also be known and obeyed. Federal laws regarding insurance and reimbursement, for example Medicare laws, apply to all physical therapists and assistants. It is your responsibility as a citizen and as a professional to know and obey the laws that affect you. Physical therapists or physical therapist assistants, who do not obey the law, may suffer consequences, such as paying a fine, providing community service or forfeiting the right to practice physical therapy by having their license to practice revoked. Having continuing education credits in ethics is a legal requirement necessary in order to have your license renewed.
See the following links to laws and regulations relative to PT practice in Texas. (These links will open a new window to see the web page from the Texas Board of PT Examiners.)
 | Texas PT Act |
| Texas PT Rules |
Ethics can be divided into two parts: professional ethics and
personal ethics. Professional ethics refers to an agreed upon set of guidelines by
a professional group. Physical therapists who are members of the APTA have
agreed to abide by the Code of Ethics that was voted upon by elected members of
the association. Being a member of the APTA is voluntary, and therefore only
members of the APTA are bound by the Code of Ethics and may suffer consequences
if they practice outside of the code. If a member of the APTA is found to be
practicing unethically by the ethics committee, the consequences could range
from receiving a reprimand to having your membership in the APTA revoked. This
of course differs from the legal obligations that apply to all physical
therapists and physical therapist assistants. The Code of Ethics and the
Standards of Ethical Conduct for the Physical Therapist Assistant provide basic
and minimal guidelines for the practice of physical therapy, such as providing
privacy for patients. These documents also provide ethical guidelines that
establish an ideal for which we should strive, such as
providing pro bono work. One thing that you should remember is that the Code of
Ethics requires that you practice legally. Therefore, you may be able to
practice legally without being ethical, but you cannot practice ethically
without practicing within the law.
If you are a member of the APTA, you have agreed to the ethical guidelines established by the association. If you are not a member of the APTA the principles outlined in the Code of Ethics are what your colleagues in the profession have determined to be important guides for practicing ethically and should be used as guides in your decision-making. That is why we will be focusing on them in this presentation. However, all physical therapists and physical therapist assistants regardless of membership in the professional association are also guided by their own sense of personal ethics. Each person practicing physical therapy should reflect upon the basic values that form the individual's core ethical guidelines for decision-making. Understanding what you value most in life, that is, what you would not want taken away from you, will help you stay grounded in an ethical awareness when difficult situations arise. Take a moment to think about what you value most. Is it your family, your life, your health, your freedom, your religion? Consider that your patients' values may differ from yours, but they may also have some similarities. For example, if you value your basic freedom to make your own decisions, then remember that your patients may also want to have that same freedom. We participate in shared goal setting with our patients for this very reason.
Personal ethics includes accepting the responsibility for your individual actions. When you make a decision to act, you also should accept the responsibility for the consequences that may occur. We will discuss how consideration of the consequences of our actions can help in making a decision before taking an action. Further, personal ethics includes being held accountable for our actions. It involves understanding and acting upon our obligations to our patients, such as recognizing the importance of truth-telling. These will be further discussed in the section on health care principles.
Although ethics and law are separate domains, the issues that we face in health care often intersect these areas. For example, the physical therapy practice act and the Code of Ethics address issues of confidentiality, and it is both illegal and unethical to reveal confidential portions of a patient's medical record. The law and ethics also overlap in the area of consent, and if you treat a patient without consent, you could be charged with battery from a legal standpoint. From an ethical perspective, not providing a patient an opportunity to voice consent to a treatment would be violating a person's basic right to autonomy. Federal laws provide protection against insurance fraud and abuse of Medicare laws. Fraud also raises ethical concerns related to harming a patient as well as those involving justice. One of the objectives of this course is for you to recognize the importance of how the ethical principles of health care, in addition to the legal requirements, can be used in making decisions about patient care.
The following case is an example of how the law and ethics overlap. Try to distinguish the difference in the legal and ethical components of the case.