Ethical Decision-Making in Physical Therapy |
Principle 4A physical therapist shall exercise sound professional judgment. There are four subsections to Principle 4. The first one addresses the assumption of professional responsibility by the physical therapist to examine, evaluate, determine a diagnosis and prognosis, treat, reexamine, modify treatment, and document progress of the patient. The therapist must practice only within the individual's scope of knowledge or refer to another practitioner. In any setting, the physical therapist must maintain the ability to make independent judgments. No matter what the financial arrangements of a practice, the therapist makes decisions based on what is best for the patient. In addition to being good business practice, the Code requires a therapist to communicate the findings of the evaluation and proposed treatment plan to the referring practitioner. Further, the therapist must not provide services to a patient if the therapist is taking any substance that impairs judgment and makes the situation unsafe for a patient. The second subsection of Principle 4 in the Guide delineates how physical therapists can delegate responsibility to other persons. It specifies what a physical therapist should perform at a minimum. Remember that the Code and the Guide often only specify minimum standards and therefore each therapist must determine the level of the quality of care that will be provided in an individual therapist's practice. Standard 6 provides guidance to physical therapist assistants in making judgments based on their qualifications. Patient safety should guide both the assistant and the therapist at all times. The third subsection of Principle 4 reminds physical therapists that the ethical obligations of the APTA apply no matter what their practice arrangement. If the therapist believes that something in their practice is causing them to conflict with the ethical standards of the APTA, the therapist should inform the employer and try to rectify the situation. When a physical therapist applies for a position in any setting, the therapist should inquire about practice arrangements that are potential ethical conflicts. A therapist who stands up for the ethical obligations of the profession is helping to maintain a strong profession that resists impulses to practice unethically. The final subsection advises physical therapists not to accept or offer gifts if there are obligatory conditions attached or if the gifts will affect the therapist's professional judgment. Trying to decide where to draw the line regarding gift giving can be difficult. Policies should be written in advance to address these situations and they should be enforced fairly. A therapist who accepts gifts gives the appearance that the patient is able to exert influence over the patient in the future. If patients who give therapists gifts receive better care than other patients, or if companies who provide gifts to staff members receive more referrals for equipment, then the therapists are acting unethically because their professional judgment is being affected by outside forces.
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