ETHICS & PROFESSIONALISM IN
PHYSICAL THERAPY
Objectives
l Discuss the basic concepts and principles of
ethics
l Identify the biomedical principles
l Discuss Realm-Individual Process Situation
(RIPS)
l Recognize the different types of ethical
situation
l Apply the standard principles in resolving
ethical dilemmas
Values and Ethics
What are Values?
l Values are enduring but dynamic beliefs
held by a person or members of an
organization about the worth of
something
l Motivate behavior
l Basis of moral judgments about right
and wrong or good and bad
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l An individual or an organization must engage
in values clarification to develop a personal
decision- making process that fosters ethical
behavior
In Philosophy:
l Terms moral and ethical are often
used interchangeably by most
health care industry workers
Morality: decisions that have significant
social importance in terms of the
way they affect the welfare of
others
l Moraldecisions- those that are correct
according to philosophical principles
l Principles
for comparing moral options
come from the field of ethics
What is morality?
lA social state governed by a specific set
of rules and focusing on the relationship
of people and how they ought to behave
toward one another in the society.
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What is ethics?
Ethics is the branch of
philosophy focusing
on morality.
Physical Therapy Ethics
l study of morality in Physical Therapy
What is the relationship of
understanding ethics in PT?
l PT staffs are faced with the challenges
of a swiftly changing medical
environment that includes redefining of
roles, advances in education, and
increases in the scope and nature of
practice
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l Physical therapists are generally
autonomous professionals delivering
services directly to patients
l In addition, PTs are increasingly
completing clinical doctorates
l Pellegrino (1999) refers to physical
therapy as a “relatively new” profession,
one in which “ethical maturity has not
yet completely evolved.”
Ethical Principles
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Basic Principles
l Autonomy
l Nonmaleficence
l Beneficence
l Justice
What is autonomy?
l Upholds the right of individuals to make
decisions about their own healthcare
l Requires that patients be told the truth
about their condition and informed
about risk and benefits of treatment
l Under the law, they are permitted to
refuse treatment
Autonomy
l Considered by some as the principle to
be followed if there are no other
principles clearly applicable
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What is beneficence?
l the act of being kind
l to bring about a positive good
l For PTs who want to help others, this
principle should seem obvious as an
obligation
Benefience
l This ethical principle is enacted by preventing,
minimizing, or eliminating actual or potential
harm that may come to another person
l Fundamental principle of healthcare
organizations
l Anything related to safety in the physical
therapy environment honors this principle
What is Nonmaleficence?
l Derived from the ancient Latin
maxim primum non nocere, meaning
"first, do no harm.“
l either by omission or commission
l Actions or practices of a healthcare
provider are “right” as long as they are
in the interest of the patient and avoid
negative consequences
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What is Nonmaleficence?
l An obligation not to inflict
harm intentionally
l Situations in which short-
term discomfort is caused
in order to bring about a
long-term benefit would
be considered under this
principle.
What is Justice?
l Speaks to equity and
fairness in treatment
l Individuals are always
to be treated equally
l Merit and individual
needs are recognized
as acceptable means
for unequal treatment
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Two Types:
l Distributive
justice
l Comparative justice
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Distributive justice
l Addresses the degree to which
healthcare services are distributed
equitably throughout society
l Within the logic of distributive justice,
we should treat similar cases similarly,
but how can we determine if cases are
indeed similar?
Comparative justice
l Determines how healthcare is delivered
at the individual level
l It looks at disparate treatment of
patients on the basis of age, disability,
gender, race, ethnicity, and religion
Principles of Justice
l To each person an equal share
l To each person according to need
l To each person according to effort
l To each person according to
contribution
l To each person according to merit
l To each person according to free
market exchanges
Ethical Principle Ex. Of Noncompliance
Autonomy Setting treatment plan and goals
for a competent client without
consulting the client
Nonmaleficence Attempting a treatment technique
without previous instruction or
experience
Beneficence Trying to do ROM on an agitated
child rather than applying a
relaxation technique
Justice Giving a competent client
personal attention and ignoring a
confused client
Other Principles:
Veracity (truthfulness)
l an element of respect for persons
l antithetical to the concept of medical
paternalism, which assumes patients
need to know only what their physicians
choose to reveal
Fidelity (loyalty)
l It speaks to the special relationship
developed between patients and their
physical therapists
l The root of fidelity is the importance of
keeping a promise, or being true to your
word
What is a Moral Dilemma?
l Itis a situation in which two or more
goods are in conflict and occurs when
an individual can rely on moral
considerations for taking each of two
opposing courses of action
What is a moral norm?
lA principle of right action binding upon
the members of a group and serving to
guide and control, or regulate proper
and acceptable behavior
l The most basic moral principles
governing academic life
l These may be expressed in institutional,
honor codes, tenure rights, and other
codes of conduct. 30
What is a moral principle?
l These are fundamental rules or codes
of conduct.
l They serve as the foundation for moral
rules and a source of justification for
actions or judgment.
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What is a Slippery Slope?
l The concept that if you act or make a
specific judgment around an ethical
concept or question, you must act or
make the same judgment in all like
circumstances.
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ETHICAL DECISION MAKING
Decision Making
la course of action that ends uncertainty
(Brecke and Garcia,1995)
Ethical Decision Making
l the level that is expected and
demanded of professionals
l the integration of ethical principles with
practical wisdom, enabling healthcare
providers to make ethical choices
(Pellegrino,1993)
Ethical Decision Making
Model
l help to organize the thoughts of an
individual
l Models include the ff:
– Kornblau and Starling Model
– Realm, Individual Process, Situation
(RIPS) model
Realm-Individual Process
Situation (RIPS) Model
l is a learning methodology for ethical
decision making in Health Sciences,
created especially by physiotherapists
in order to solve ethical problems of this
profession
l essentially involves four steps
Realm-Individual Process
Situation (RIPS) Model
Step 1: Recognize and define the ethical
issues
Step 2: Reflect
Step 3: Decide the right thing to do
Step 4: Implement, evaluate, reassess
Step 1: Recognize and define
the ethical issues
l Three Realms of Managed Care Ethics
l Four Components of Moral Behavior
l Types of Ethical Situations
Three Realms of Managed
Care Ethics
Individual realm
- concerned with the good of the
patient/client and focuses on rights, duties,
relationships,and behaviors between
individuals
- deals with the least complex problems
Three Realms of Managed
Care Ethics
Institutional/organizational realm
- concerned with the good of the
organization and focuses on structures
and systems that will facilitate
organizational or institutional goals
Three Realms of Managed
Care Ethics
Societal realm
- concerned with the common good and is
the most complex realm
Source: Glaser, 1994
Individual Process:
Four Components of Moral Behavior
l Moral sensitivity involves recognizing,
interpreting, and framing ethical
situations
l Moral judgment requires deciding on
right versus wrong actions; process
involves generating options, selecting,
and applying ethical principles
Individual Process:
Four Components of Moral Behavior
l Moral motivation places a priority on
ethical values over other values, such
as self-interest, status, or financial gain;
Professionalism is a primary “motivator”
for ethical behavior
l Moral courage involves implementing
the chosen ethical action, including the
development of a plan and
perseverance in the face of barriers and
adversity. Source: Rest & Rest, 1999
Types of Ethical Situations
Step 2: Reflect
l determine whether it is a right versus
wrong situation
Four simple tests for right
versus wrong situations
Legal test – Is something illegal? (Be
aware of your Practice Act and the Rules
and Regulations that interpret the Act)
- If so, it is probably not a true dilemma
but a “hard choice.”
Stench test – Does it “feel” wrong? Such
as, “gut” reaction?
Four simple tests for right
versus wrong situations
Front-page test – How would you like
this on the front-page of your local
newspaper?
Mom test – If I were my mother (or
parent), would I do this?
Additional Test
Professional Ethics Test – Does the
Code of Ethics, Guide for Professional
Conduct for the PT, Standards of Ethical
Conduct, Guide for Conduct of the PTA,
or Core Values prohibit or discourage the
action?
Source: Kidder, 1995
Step 3: Decide the right thing
to do
l specificallyfor theresolution of ethical
dilemmas, i.e., those situations in which
there are two conflicting courses of
actions that appear to be right
l “right versus right”
Three basic approaches to
resolving dilemmas:
l Rule-based – follow the rules, duties,
obligations, or ethical principles already in
place
l Ends-based – determine the
consequences or outcomes of alternative
actions and the good or harm that will
result for all of the stakeholders
l Care-based – Resolve dilemmas
according to relationships and concern for
Source: Kidder, 1995
others
Step 4: Implement, evaluate,
reassess
l implementation of decision
l especially important in situations of
“right versus wrong” and in situations
where there may be organizational or
societal barriers to your proposed
course of action
l calls for personal reflection and
professional growth
Template for Ethical Decision
Making Using the RIPS Model
Template for Ethical Decision
Making Using the RIPS Model
Template for Ethical Decision
Making Using the RIPS Model
Template for Ethical Decision
Making Using the RIPS Model
Source: Nordrum, 2009
Application
l Givea situation where the RIPS Model
is applied
End of lecture
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