Reports of ethics violations in government, industry, and the financial world have captured the attention of the public in recent times. The omnipresent nature of today’s news media contributes to the revelation of misdoings in a way never seen before. In every sector of the economy, ethical violations make news. In medicine, the topic of ethics evolved slowly from the 2500-year-old Oath of Hippocrates over many centuries to the biomedical ethics of today (Edelstein, 1967; Sugarman, 2000). The body of knowledge around ethical theory is evolving rapidly now, fed by challenges that the healthcare delivery system places on practitioners as well as significant changes in healthcare that present new challenges for providers such as the use of digital healthcare data (Aicardi et al., 2016; Kirsch, 2017; Means et al., 2015; Pasztor, 2015; Wells et al., 2015).
Society demands exceptional behavior from its healthcare practitioners, and currently, there is increased awareness when ethical breaches occur as well as renewed expectation of a high level of ethical behavior (Tenery, 2016). Physical therapists (PTs) often find themselves at the forefront of ethical decision-making. Because it is not possible to behave ethically without a thorough understanding of the standards of practice for one’s own healthcare field, this book is designed to help clinicians to utilize guidelines for making good ethical decisions in physical therapy practice (Dubois, 2018, Marques, 2012; Quigley, 2015).
Healthcare providers recognize they are entrusted with a special relationship with their patients, one based on trust. This is one of the pillars of professionalism, which is the foundation of the societal contract (Cruess, 2006). Healthcare providers have a special fiduciary responsibility to patients who generally have an injury or disability providing special challenges because of their increased vulnerability within the general population. Yet, even though PTs understand the need to make ethics-based clinical decisions, their ethical decision-making skills may be underdeveloped (Hudon et al., 2015; Naamanka et al., 2020; Strum, 2023). All physical therapy providers are faced with the challenges of a swiftly changing medical environment that includes redefining of roles, advances in education, and increases in the scope and nature of practice, all factors that challenge professional behaviors and require the education and training to manage the ethical decision-making that is always integral to clinical decision-making (Brody and Doukas, 2014; Miles and Prasad, 2016; Murrell, 2014).
PTs are generally independent professionals delivering services directly to patients. In addition, the entry-level education of PTs in the United States is the clinical doctorate. As of 2017 all CAPTE-accredited schools require that the Doctor of Physical Therapy be the entry-level degree (CAPTE, 2016). This raises public expectations of the level of practice of a PT. The public’s demand for transparency and the growing visibility of other healthcare providers have increased the pressure on all health providers and other non-physicians to be more accountable for their actions. Pellegrino (1999) refers to physical therapy as a “relatively new” ...