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INTRODUCTION

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Unless otherwise noted, cases were previously published in PT in Motion and are adapted with permission from the American Physical Therapy Association.

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The next section of this book consists of case commentaries and opportunities for discussion. The most effective way to incorporate ethical decision making into clinical practice is to have the opportunity to have case discussions. This section allows you to use these case discussions in a variety of ways.

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They can be discussed in a large group, or the elements of the ethical decision-making process can be analyzed individually and then discussed in a variety of types of feedback sessions.

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Regardless of how the cases are utilized they are arranged to provide the physical therapist and student with opportunities to develop clinical ethical decision-making skills that complement their clinical decision-making abilities.

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There are eight case sections in this portion of the book. Cases are placed in the appropriate section to demonstrate the wide variety of ethical issues that confront practitioners. There is of course considerable overlap between the cases and the issues that they portray. Discussing multiple cases in a section can reinforce the fact that often a similar type of issue will present itself very differently, but a clinician using an organized form of analysis will recognize common features to help them manage the specific situation before them. At the end of each case, there is a section entitled Consider and Reflect; this allows the reader an opportunity to look into the thought processes of the primary stakeholders. Examining the situation from the perspective of the main characters may help frame your ethical decision making.

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There are many ways in which your opinion may differ from other clinicians, and you may have a very different take on the situation you are encouraged to provide that. However, it is important that you always approach an ethical decision using an ethical decision-making process. Initially this may seem a bit “clunky,” but it will become part of your systematic thinking just as the structure of a patient evaluation becomes natural and fluid.

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There is one other thing to keep in mind when developing an ethical response. Resolution of one issue may result in an adverse effect for some stakeholders, and it is important to keep the idea of “collateral damages” in mind and weigh whether or not the actions decided upon are worth the potential problems.

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This introduction starts with a fully developed case, to provide guidance into one way in which this case can be analyzed. There are many ways to analyze an ethical issue, but what they have in common is a systematic approach that provides the clinician with common factors that are easily referred to in future analysis. As clinical experience develops so should all of the professional behaviors that include the ethical foundations for clinical practice.

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