Code of Ethics
Principle 2
A physical therapist shall act in a trustworthy manner towards patients/clients, and in all other aspects of physical therapy practice.
Principle 2 also invokes one of the health care virtues, which is
trustworthiness. It specifically includes issues not just involving patient and
clients, but "all other aspects of physical therapy practice." This
important principle addresses several issues of trustworthiness, and needs to be
clearly understood. As we discussed earlier, patients are vulnerable and
physical therapists must guard against any form of exploitation of patients.
Section 2.1 C. of Principle 2 needs to be fully quoted so that there are no
misunderstandings. It says: "A physical therapist shall not engage in any
sexual relationship or activity, 
whether
consensual or nonconsensual, with any patient while a physical therapist/patient
relationship exists" (italics mine). This is also a part of Standard 2 and
applies in the same way to physical therapist assistants. While this statement
seems clear, and it is also a tenet of the practice act, some therapists
continue to believe that if a patient consents, that is not wrong to enter into
a sexual relationship. Even if the therapist and the patient "fall in
love," as long as there is a therapist-patient relationship, having sexual
relations is unethical and illegal. Remember that we spend a great deal of time
in close proximity to our patients, and it is easy to develop personal
relationships with some patients. Most physical therapists are friendly and
compassionate persons and our patients respond to our good care. It is important
to maintain professional boundaries with our patients while a patient/therapist
relationship exists.
Principle 2 also addresses truthfulness and the importance of not making statements that are knowingly "false, deceptive, fraudulent, or unfair." In addition, the principle discusses how confidential information should be handled and describes the appropriate circumstances and mechanisms for disclosing information if necessary. Read this part of the Code and the Guide carefully because it is also reflective of the law. Confidentiality is derived from the principle of respecting a person's autonomy, and patients have the ethical and legal right to have their private information kept private. This seems like a straightforward principle, but it becomes a difficult ethical issue when the public's health is involved. The issue of reporting AIDS patients' names to the authorities is a good example of how difficult this can be. In this example, the principle of respect for autonomy conflicts with the principle of nonmaleficence. There is an ethical obligation to preserve the right of privacy to the individual, but there is also the legal obligation to protect the public.
HIPPA is now imposing legal standards of confidentiality, but we should always remember that the ethical basis of this issue is respecting the rights of the patient. Confidentiality needs to be addressed frequently in our clinical environments. We need to raise our awareness and renew our concern for the confidentiality of our patients. For example, we should not discuss patients in public places, including the nurses' station where the public could overhear our conversations. Discussing patients with students while riding an elevator often violates our obligation to our patients to maintain the confidentiality of their information.
The final subsection of Principle 2 addresses the issue of patient autonomy and informed consent. As discussed earlier, informed consent is derived from the principle of respect for a person's autonomy. Our patients cannot know whether they want to participate in our treatment programs unless they are informed about the proposed treatment, potential risks or harms, alternatives, and goals of the treatment. Physical therapists should be particularly sensitive to beginning treatments on patients that involve touching the patient on the trunk without informed consent. Therapists should use drawings, anatomical charts, or models to clearly describe where, how and why the patient will be touched. Physical therapists for too long have presumed that patients give consent, but from an ethical standpoint, the patient should express informed consent in order for the patient's right of autonomy to be respected. The Guide provides an example of how physical therapists participate in informed consent. That is, we "collaborate" with patients in setting treatment goals and a plan of care.
As you read the following case, think of how you could have done things differently to achieve another outcome.