Preface

Over the past century in the United States, physical therapy evolved from a technical field to a doctoring profession. This evolution reflects significant growth in the body of knowledge that a clinician must acquire and apply. Even more significant than the growth in technical skills are the demands of professional behavior that the practice of physical therapy now requires. When physical therapists (PTs) worked under the direction of another healthcare provider, ethical decisions were often seemingly out of their control. Decisions about patient care and access to care were influenced and controlled by others, rather than the treating physical therapist. The changes in the profession are reflected in the changes in the Code of Ethics that provides guidance to practicing PTs. The very first Code of Ethics introduced in the late 1920s addressed primarily the individual realm, our relationship with our patients, and the relationship with our colleagues. The revisions of the Code during the next several decades did not change this frame of reference very much. As a nascent profession, PT was very inwardly focused, and the patient-therapist relationship was of course the center of that focus.

The very nature of physical therapy—the close physical and personal connection between PTs and their patients—makes the discipline one that is often perched precariously on the slippery slope of boundary violations, dual relationships, institutional and supervisory power gradient challenges, and a host of other potentially difficult situations. For over 10 years, the professional association dedicated space monthly for the discussion of ethical issues that apply to all clinicians regardless of setting or field of practice. This text was designed to give practical ethics a home, to provide tools that both students and clinicians could easily use to become facile in managing ethical challenges in practice. The cases are set up to encourage discussion. The text provides a framework to answer the “should” questions. What should I do? How should I act? The format provides the opportunity to move beyond the individual realm, when appropriate, resolving issues within an institutional or societal perspective.

This text is divided into two separate and discrete sections. They are designed to integrate with one another, but each section can also be used separately. There are also online resources to help provide some guidance for the cases. Physical therapy ethics is a dynamic and evolving field of study and a constantly changing part of clinical practice. Practical guidance is often best incorporated into practice through activities that involve dialogue between clinicians, and, though this book is focused on physical therapy cases, they are real-world situations that are appropriate for a multidisciplinary discussion.

The purpose of this text is to give students and clinicians a lens through which to analyze contemporary ethical challenges. Philosophical theory within the text is limited to that which can be applied practically in the clinical setting. A suggested model for ethical decision making is introduced and applied, but it is not the only way in which to approach and resolve ethical situations. Ethical decision making is a component of clinical decision making, and they share to an extent reasonable ambiguity. The challenge for all of us is to become comfortable and confident in working with an amount of uncertainty. The question always arises, “Can we teach somebody to be ethical?” This text is not a primer on ethical behavior; it is designed to provide students and clinicians with a framework in which to approach the uncertainty of ethical decision making with tools to aid their inherent judgment. Discussions of professional issues, the “what should I do” questions are stimulating and force us to reach into the depths of our reasoning acumen. It is hoped that whether you use this text as a future physical therapist, a clinician, or an educator you will appreciate the privilege we have as healthcare providers to engage in these professional discussions that improve the lives of our patients and encourage us to continue to do what is right, what is responsible, and what leads to consistent safe and effective clinical practice.