Subject: Professional Issues 03

Topic: Module 2

OUTLINE ethics is integral to professions like physical therapy.

I. LESSON 1-2 What are professions? In a loose sense, professions
A. PHYSICAL THERAPY AS A PROFESSION include all ways of making a living: thus, professional
a. ADVANCED EXPERTISE athletes, spies, and even murderers.
b. INDEPENDENT JUDGMENT
c. SOCIAL ORGANIZATION Professions meet four criteria: advanced expertise
d. COMMITMENT TO THE PUBLIC and education, independent judgment, social
GOOD
organization and recognition, and commitment to the
B. CODE OF ETHICS
C. PT AS A PROFESSION public good. Accordingly, physical therapy is a
D. PROFESSIONAL ETHICS profession if it meets these criteria, and surely it does.
E. RESOLVING ETHICAL DILEMMAS a. Advanced expertise
a. MORAL REASONS
b. FACTS combines sophisticated practical skills with a strong
c. OPTIONS AND OUTCOMES grounding in sophisticated theory. Stated in another
d. DELIBERATION AND DECISION way, professional expertise combines practical know-
e. ACTION how with “knowing-that” (numerous theory-based
f. REVIEW facts).
F. MORAL REASONING
G. GOOD JUDGMENT b. Independent judgment
H. SAMPLE CASE
implies the need for discretion—in contrast with merely
II. LESSON 3-4
A. WHAT IS AUTONOMY? mechanical or routine procedures—in making
B. AUTONOMY diagnoses of problems, considering alternative
C. PRINCIPLES OF AUTONOMY solutions, and reaching sound verdicts about how to
a. INFORMED CONSENT proceed. Traditionally, so-called “true professionals”
b. VERACITY were said to act independently on their own judgment,
c. CONFIDENTIALITY without supervision by others.
D. PATIENT CARE
c. Social organization
a. HEALTH-CARE PROVIDER AND
PATIENTS
typically includes one national professional society—
b. HEALTH-CARE PROVIDER AND
OTHER PROFESSIONALS
such as the American Medical Association, the
c. HEALTH-CARE PROVIDER AND American Bar Association, and the American Physical
WIDER COMMUNITIES Therapy Association—together with organizations
E. CASE SAMPLES within each state. Social recognition means that the
III. LESSON 5-6 profession, through its professional organization, wins
A. WHAT IS CULTURAL COMPETENCY? support from state and national governments to
B. CULTURE educate, license, discipline, and in other ways regulate
C. COMPETENCE
its membership.
D. INDIVIDUALISTIC CULTURES
E. COLLECTIVIST CULTURES d. Commitment to the public good
F. STAGES OF DEVELOPING
G. CULTURAL COMPENTENCY refers to a shared devotion to some public good or to
H. PREJUDICE OR BIGOTRY some aspect of the good of society.
I. PEOPLE WITH DISABILITIES B. Code of Ethics
a. DISABILITY IS DEFINED IN THREE
DISTINCT WAYS: Provide guidance to professionals for moral dilemmas.
J. SEXISM
a. EARNINGS BY GENDER Establish a fair playing field that reduces cutthroat
K. RACE & RACISM competition.

References: PowerPoint and Recording Give support to professionals who are sometimes
Legend: asked by their employer to "cut" corners in the name
M ain Topic of profit.
Main-Sub Topic
Sub Topic Serves as the official statement by a profession that
Book PPT Side notes Speaker
they are committed to promoting the public good.

Promote public trust

C. PT AS A PROFESSION

I. LESSON 1-2 Theory+ Skill/Practice

A. Physical Therapy as a Profession PT Assessment & Dx
Regardless of how we characterize ethics, clearly PPTA/APTA

Compiled and Transcripted by: Dominic C Castañeda (Riverside College Inc.- Bachelor of Science in Physical Therapy)
 F. Moral Reasoning
Code of Ethics
D. Professional Ethics Moral reasoning is a thinking process with the
objective of determining whether an idea is right or
Ethical dimensions in professions are needed to: wrong.
o Have clear boundaries
o Have commonly accepted norms of behavior To know whether something is "right" or "wrong" one
o Enhance respect within and outside the must first know what that something is intended to
profession accomplish.
o Protect the rights of the consumer/ client
Clinical Competence
o Protect the rights and privileges of the
o to the capability to perform acceptably those
professional
duties directly related to patient care.
E. Resolving Ethical Dilemmas
G. Good Judgment
Let us now return to ethical (or moral) dilemmas,
“To choose worthy goals and set proper priorities,
which are situations in which moral reasons come into
thinking through the consequences of your actions;
conflict. Such dilemmas are commonplace in the
and basing your decisions on practical wisdom and
professions, as elsewhere, because moral values are
good sense.”
many and varied and enter into life in innumerable
ways. The following steps are typically involved in I swear to fulfil, to the best of my ability and
responding to ethical dilemmas. judgment, this covenant:
To further illustrate how these steps apply , please Conduct myself in a manner which is morally and
read Case 1.1 (found at the first Chapter page) in page ethically sound
9-12 of Physical Therapy Ethics 2nd Edition by Donald H. SAMPLE CASE
Gabard and Mike Martin
Hillary is an in-house PT to a local university; her duties consist
a. Moral Reasons primarily of screening athletes during the preseason and
Identify the conflicting moral reasons that comprise treating injuries during practice or games. Currently she is
the ethical dilemma. Moral reasons take many forms. treating Donald, the school’s star wrestler and weight-lifter, for
They include responsibilities (obligations, duties), a minor tear in his biceps brachii tendon. She notices excessive
rights (both general human rights and specific rights muscle hypertrophy as the tear heals. Because she knows that
created by contracts), good and bad consequences, anabolic steroids are a common cause of such problems, she
valuable relationships, ideals, and virtues (good immediately urges him to stop. But Donald refuses to listen and
features of character). at one point he uses threatening tone that makes Hillary feel
her job at jeopardy. In addition, the coach is known to be an
b. Facts
aggressive competitor and lackadaisical about drugs. What
Identify the relevant factual information—relevant in should Hillary do and why?
terms of the moral reasons applicable in the situation. II. LESSON 3-4
This includes the applicable laws and policies. Identify A. What is Autonomy?
the relevant stakeholders—that is, people and groups
directly affected by how the dilemma is resolved. MORAL AUTONOMY
c. Options and Outcomes o Is the moral authority or right to make one’s
own decisions.
Identify the realistic options in resolving the dilemma
and their likely outcomes. PSYCHOLOGICAL AUTONOMY
d. Deliberation and Decision o Is the competency to make one’s own
decisions and ability to reason and act
Make a reasonable decision by deliberating to discover rationally.
the option that most reasonably balances and
integrates the moral reasons. (Occasionally more than
one option can provide a reasonable solution.)
e. Action

Take action; implement your decision.

f. Review

Reflectively review your process, and assess the

outcomes. Look for ways to improve the process by
identifying procedural hurdles or barriers, and assess if
procedural changes are needed for the future.

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 divulging it to unauthorized persons.
C. Patient Care
RELATIONSHIP-CENTERED CARE
o The Pew-Fetzer Task Force developed such
model: “ The Phrase ‘relationship centered
care’ captures the importance of the
interaction among people as the foundation
of any therapeutic or healing process”

a. PEOPLE REFERS TO: Health-care provider and

A. Autonomy Patients

Medical Paternalism
o View that physicians are justified in
promoting the well being of patients as
defined by the physician, regardless of
whether patient gives prior consent.

Weak Paternalism
o Is interfering with others’ liberty to prevent
them from harming themselves.

Strong Paternalism
o Is interfering with others’ liberty for the
purpose of promoting their good.
B. Autonomy b. PEOPLE REFERS TO: Health-care provider and
Informed Consent other professionals

Veracity

Confidentiality
a. Informed Consent

For patients to give informed consent , 3 conditions

must be met: Information, Voluntariness and
Competence.
o INFORMATION
 Patient must be given relevant
information concerning their
condition and treatment options in a
manner they can understand.
o VOLUNTARINESS
 Patients must be free to make c. PEOPLE REFERS TO: Health-care provider and
decisions without being coerced or wider communities
otherwise manipulated.
o COMPETENCE
 Patients must be sufficiently rational
or competent to understand and
make health-care decisions.
b. Veracity

The duty to tell the truth to patients is also called the

principle of veracity, honesty, or truthfulness.
c. Confidentiality

The duty of confidentiality is the duty to maintain

privacy of information concerning patients by not

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 D. CASE SAMPLE Ms. Cargill was born with abnormally small kidneys that
Muriel Thomas is a 76-year-old widow who, as a consequence eventually gave way, necessitating a kidney transplant.12 She
of a fall, had a hip replacement. Her only living relative is a son, lives in a sheltered home environment, appropriate for her mild
who shows little interest in her. Almost everyone in the mental retardation. When she applied to the Oklahoma
rehabilitation unit recognizes that most of Muriel’s complaints University Medical Center, she was told that she was not a
are not related to the replacement but instead are thinly veiled candidate because she probably could not give informed
attempts to get attention. She complains of various pains that consent due to her diminished capacity. This judgment was
change location and have no obvious connection to her injury, reached despite the fact that the state of Oklahoma considered
surgery, or therapy. Her functional status with a walker is her competent to make all her decisions. It was true that she
nearly where it was prior to the accident. Although the was in a supervised living situation, but she held a job and did
physician and the therapist agree that therapy goals have all the ordinary things people do, including having a boyfriend.
almost been achieved and should be discontinued in a week or As her condition worsened, her caseworker reluctantly appealed
so, the physician asks the therapist to make up some kind of to Adult Protection Services to become her legal guardian. That
treatment to appease her complaints. The physician states that agency refused, stating that she was competent. Although Ms.
the attention will probably make the pains go away, at least Cargill signed a consent form allowing the hospital to respond
until she is discharged. The physician also states that she will to reporters, following the publicity of her rejection as a
enter a diagnosis that will allow insurance to cover the therapist transplant recipient, the hospital ruled that she was not
so that no revenue will be lost to the department. The therapist competent to give that consent.
complied and started administering low levels of ultra- sound to III. LESSON 5-6
Muriel’s forearm, the site of her most recent “pain.” Much to the A. What is Cultural Competency?
therapist’s surprise, Muriel asked her directly how this therapy
was supposed to help. B. CULTURE
What are the moral issues in this case, and how do you think Refers to integrated patterns of human behavior that
they should have been handled? include language, thought, communications, actions,
customs, etc.
Andrew Gordon is a 43-year-old contractor who fractured his C. COMPETENCE
right tibia in a fall from a scaffold.25 Mr. Gordon has been
hospitalized for three weeks because the fracture is not healing Implies having capacity to function effectively as an
quickly. A fever prompts tests that reveal lymphosarcoma, a individual and an Organization within the context of
cancer likely to be fatal within a year. His physician, Dr. cultural beliefs.
Hammill, calls Kim Segard, the physical therapist, to say that he D. INDIVIDUALISTIC CULTURES
has talked with Mrs. Gordon and they have agreed that Mr.
Gordon would not want to know the truth. The physician does, Focus on Autonomy and Individual Rights.
however, ask Kim whether Mr. Gordon has said anything As a consequence, elements that contribute to
suggesting he would want to know the truth. Kim reports that individual security, such as competitiveness and
he had not. But 10 days later Mr. Gordon does say to Kim, “I planning for the future, are very important.
have come to trust your judgment. . . . I’ve tried to cooperate
with the doctors and everyone, but I have a feeling that
E. COLLECTIVIST CULTURES
something funny is going on that I can’t get at. My wife and Dr. Focus on group well-being and interactions.
Hammill are acting strange and that is scaring me. . . . Do I
have cancer or some fatal illness?” Communities are marked by their cooperation and
concern with traditions as a mean of perpetuating the
past into present and future.
Larry Dulles is a 26-year-old man being treated in physical F. STAGES OF DEVELOPING CULTURAL
therapy for generalized weakness and neurological problems COMPENTENCY
associated with acquired immunodeficiency syndrome (AIDS).
One day his mother took him to therapy. After his treatment STAGE ONE
session, she remarked to his therapist that he did not seem to o Develop knowledge of self and how one’s self
be improving. The therapist said, “Well, we don’t always see is influenced by one’s culture and beliefs.
dramatic changes with AIDS patients.” Larry’s mother was
STAGE TWO
previously unaware of his diagnosis.
o Develop awareness of people who have their
own values, and willingness to treat others as
they wish to be treated.

STAGE THREE
o Develop the ability to empathize with and to
respect individuals having different
worldview.

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 G. STAGES OF DEVELOPING CULTURAL K. RACE & RACISM
COMPENTENCY
In practice, race, as most commonly used is defined
Is the strongest obstacle to multicultural appreciation. by skin color, hair texture and other appearance
variables.
Although prejudice can involve prejudging someone
favorably but the greater threat to justice occurs when Many scientists are now convinced that the idea of
people prejudge negatively. biologically different races - dividing the one human
H. STAGES OF DEVELOPING CULTURAL race – is a product of racism.
COMPENTENCY
PEOPLE WITH DISABILITIES

The problem with this language is that

it is not accurate; the person is not

the characteristic.
I. PEOPLE WITH DISABILITIES
In addition, this language reinforces the limiting
perspectives that a stigmatizing “mark” taints all other
characteristics of a person
a. DISABILITY IS DEFINED IN THREE DISTINCT
WAYS:

First, persons are disabled if they have a physical or

mental problem that substantially limits a major life
activity.

Second, all individuals who have been substantially

limited in the past are covered.
Third, inclusion extends to situations where a problem
is created by the attitudes of others.
J. SEXISM
The bias against women might be the most systematic
bias in society because it is prevalent in every aspect
of life.

Historically, women “were expected to be continually

dependent upon men -upon fathers in childhood, on
husbands as adults and on sons in old age.
a. EARNINGS BY GENDER

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