How to Use This Book

There are two parts to this book. Part One provides more didactic, foundational material, while Part Two strives to apply ethical decision-making tools to relevant cases in physical therapy practice. The two parts are meant to be used together, but they also can stand alone, providing basic conceptual material about ethics, and ethical decision making in physical therapy practice, with the second section focusing on case analysis.

Part One begins with foundational material that serves as a good introduction for students and a light review for practicing clinicians. Each chapter in Part One concludes with Ideas to Consider multiple-choice questions meant to reinforce comprehension. Chapter 1 introduces the reader to healthcare ethics with a brief overview of how ethical decision making has evolved. It is not the intention of the book to make the reader a bioethicist. Rather the chapter introduces the terms used in the field of bioethics, with the clinical relevance highlighted and referring to the Code of Ethics to provide a practical application of the term. The chapter also gives us insight into our responsibility to take action, exercise moral potency, and not to be passive in the relationship that benefits those who have entrusted their care to us. The chapter concludes with a brief discussion of the relationship of ethics and law. Chapter 2 establishes the framework of professionalism and sets the foundation for ethical decision making firmly on the patient-therapist relationship; the importance of trust and the dynamic involved in that trust are developed in this chapter. Chapter 3 can stand alone, independent of any other aspect of the text, but it is also a foundation to understanding how we as physical therapists and physical therapist assistants are expected to behave. It delves into each of the principles and standards of the Code of Ethics for the physical therapist and the Standards of Ethical Conduct of the physical therapist assistant. To work together effectively the PT and the PTA must understand their own ethical obligations as well as those of their colleagues. Chapter 4 addresses the “unthinkable,” the fact that any one of us can easily engage in an ethical breech, because just like our patients we are human and not infallible. This chapter lends itself to introspection—how many of the risk factors identified have I had in the past, or currently have, or may have in the future—and suggestions are offered for how to recognize potential risks and how to mitigate those risks if possible.

Chapter 5 is the heart of the ethical decision-making portion of the text, and if you are planning to use just the cases you would benefit from first reviewing this chapter to provide the context for efficient ways in which to use the suggested decision-making model. Two cases are presented and developed fully to model an extensive ethical decision-making framework. When using the cases in Part Two, it is often helpful to return to this chapter to review application of the decision-making frameworks. Ethical decision making is what is expected of professionals by the public we are privileged to work with. The complications in ethical decision making arise not just from the individual relationships we have with patients but on the confounding factors that develop because of the influences of the institutions and organizations and the societal pressures that impact our practice. With each passing day, and each technological advance, the questions become more complex impacted by resource allocation and technological advances. This chapter poses the quandry that we are consistently faced with: “just because we can, doesn’t mean we should.” The final chapter in Part One, Chapter 6, looks to the future, that which challenges us today will always be just a part of what will challenge us tomorrow, and as professionals we have an obligation to keep up with not just clinical advances, but also with the new ethical challenges that arise from the technological changes.

Part Two of the text is designed to be integrated with Part One, or it can stand alone for clinical or class discussions. The cases are divided into the major areas in which ethical decisions fall in clinical practice. Each section has three cases. When used in a clinical setting, cases can be used independently to encourage discussion or to stimulate thought as background for a clinically relevant case in the setting in which you are practicing. In the classroom setting, the three cases per section allow you many options about how to use the cases either in a dedicated ethics or professional issues class or to integrate the cases into clinical courses as they may be applicable to that course content. You can use one case to introduce the process in the classroom and then use subsequent cases for either individual work to be discussed in class or group work. Chapter 7 provides an introduction to case analysis, guiding the reader through a case with suggestions on how the case analysis process could be applied. Chapter 8 deals with cases having to do with professional accountability, particularly when the PT is navigating the many entities to whom they are accountable to. Chapter 9 navigates the always-tricky area of boundary issues. In a profession that gets so close to its patients physically and emotionally, boundary awareness is critical, and boundary breeches are always a concern. Chapter 10 covers the broad spectrum of practice issues. PTs treat patients across the lifespan, in a myriad of practice settings, and though each situation is unique the basic responsibilities of the physical therapist remain constant, regardless of setting or patient presentation. This chapter is focused on helping the PT drill down to the core parameters of ethical practice. Chapter 11 traverses the complex but critical area of intraprofessional and interprofessional relationships, both of which are critical to maintaining a productive working environment. The cases speak to the carefully traversed path between the necessity to be autonomous in our decision making but also collaborative and not isolated in our practice. Chapter 12 addresses professional responsibility. This complex relationship that we have with the institutions that impact our practice is most important to understand in the context of our responsibility to our colleagues, profession, and most importantly our patients. The cases in this chapter explore professional responsibility from various perspectives. Chapter 13 addresses self-regulation. Every professional has the responsibility to regulate himself or herself, as well as the responsibility to be accountable for the regulation of physical therapy practice. The public grants professionals the right to regulate their own practice and with that comes the responsibility of professionals to be deliberate and thoughtful about what that responsibility requires. Chapter 14 traverses the complex world of supervision and being supervised. It is built on the premise that delegation does not mean abdication. These cases look at the responsibility of the supervisor as well as the responsibility of the person being supervised. The ultimate responsibility, whether supervisor or supervisee, lies with the individual licensee, often leading to some very complicated ethical situations. Chapter 15, the final chapter in the book, navigates the very special relationship of the novice, the student physical therapist, with his or her future profession. There is a uniqueness to healthcare education that requires a considerable amount of on-the-job training as part of the formal education. This training, while highly beneficial, places unique and complex responsibilities on both the student and the licensed clinician. Many of the issues discussed in previous chapters impact the student–clinical instructor relationship, but there are some situations that are unique to this very special student, teacher, mentor, and future colleague relationship.

The challenge of this text is to keep it constantly relevant and current, providing new cases via online resources that reflect new professional challenges. But the text itself, with its foundation in principle and application, should endure and provide continued meaning and relevance to inform clinical practice and encourage practitioners to consistently strive to do what is right because it is right.