The bioethical principles presented in Chapter 1 set the framework for ethical decision making and will undergird the analysis of the case study that follows demonstrating ethical decision making in the clinical setting. A grasp of these basic principles provides the template for sound clinical decision making. The actual way in which clinicians arrive at ethical decisions is continues to be studied and refined, with a deeper connection to the clinical aspect of decision making. Clearly, ethical and clinical decision-making models must overlap significantly to derive a satisfactory outcome (Dale, 2016; Drumwright, 2015; Kearney and Penque, 2012; Sujdak and Birgitta, 2016).
When physical therapists (PTs) worked under the direction of a medical doctor, many of the opportunities for ethical decision making were usurped by the hierarchy of that relationship. PTs often recognized an ethical challenge but generally felt constrained in their ability to manage it as they did not have the primary responsibility for the situation. A different professional landscape is evolving as a result of the changes in practice that emerged since all jurisdictions adopted direct access for physical therapy services. During this same time period all CAPTE accredited programs were required to offer degrees at the doctoral level. PTs must take charge of their ethical decision making recognizing that the power that provides for independent decision making also demands collaboration and requires taking responsibility for all the aspects of clinical decisions.
THE ETHICAL DECISION-MAKING PROCESS
Ethical decision making is a challenge to physical therapy professionals, who face increase in the number of both issues and situations that are increasingly complicated. Ethical decision-making skills are enhanced by studying cases and developing a strategy for facing ethical issues. All practitioners recognize that clinicians don’t always have complete control over the situations that confront them. It is the responsibility of the clinician to maintain the focus on the centrality of the patient. When the welfare of the patient is compromised, the healthcare provider is challenged to manage the situation in the patient’s best interest (Airth-Kindree and Kirkhorn, 2016; O’Fallon and Butterfield, 2005; Osswald et al., 2009; Rate et al., 2007).
Making decisions is part of everyday living, whether it is deciding what to wear, what to cook for dinner, or what type of vacation to plan. For the most part, these decisions are part of an automatic, and therefore unconscious, process. But there are other decisions, particularly those related to professional practice, that are not automatic. For example, we are often confronted with two equally appropriate choices. Kidder calls this a right vs. right dilemma. When evaluating the alternatives, both courses of action have positive and negative elements. Right vs. right is an ethical dilemma, whereas right vs. wrong is identified as a moral temptation. The individual knows the right thing to do, but chooses the action that is wrong (Kidder, 1996).