Nonmaleficence
The principle of nonmaleficence is an obligation not to inflict harm intentionally. Most persons who choose a health care career only want to help people, not harm them, so this principle would seem easy to apply. Further, the obligations of not harming are generally considered more stringent than those of helping. One way to remember the meaning of this principle is to think of the phrase in the Hippocratic oath, "To first do no harm." Usually issues of nonmaleficence are discussed when patients are at the end of life. We often must decide if continuing treatments cause the patient more harm than benefit.
Since nonmaleficence is often a consideration in end-of-life decisions,
physical therapists are not often involved in the actual decision-making about
withdrawing or withholding life-sustaining treatments on patients. Yet physical
therapists and assistants often provide treatments to patients who may discuss
these treatment options with them. Patients, family members or surrogates may
talk with you about whether they want a feeding tube or a respirator continued.
Since therapists often spend significant amounts of time with patients, they may
confide in you their wishes regarding end-of-life care. Patients may express a
desire to be left alone to die without all of the tubes or they may tell you
that they are waiting for a certain family member to arrive. As a member of the
health care team you should provide this information to the physician or nurse.
Physical therapists who often treat dying patients should seek to be on the
institutional ethics committee so that their patients' wishes can be made known
as decisions are made.
Specific physical therapy treatments may also be uncomfortable to patients. It is a difficult ethical decision whether to continue treatments on patients who may not receive much long-term benefit from the treatment. The patient's quality of life and the patient's wishes should be considered, not necessarily what the physical therapist believes is "right" for the patient.