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Knowing the right thing to do, doesn’t always mean we will do it.

Healthcare professionals accept the obligation to answer to a set of ethical standards that are more demanding that those incumbent on the general population. Nobody expects that their ethical values will be challenged during their professional career, so the question arises why do people find themselves with ethical breaches and is there something they could have done to prevent these lapses? There has been little formal work done in this area. Some early observations and data, gathered primarily through interviewing individuals to see where moral breakdown may have occurred, resulted in some interesting findings. Across healthcare fields, medicine, nursing, and of course physical therapy, some common factors have been identified as not the only cause for an ethical breach but was certainly a contributing factor. Recognizing some of the potential contributing factors can be helpful for all practitioners in their effort to avoid an ethical behavioral lapse (Welsh and Ordonez, 2014).

Some of the most common factors are identified in Table 5-1. They are not in order of importance, as that depth of inquiry has not been done yet on ethical risk factors. The PT Professional Liability Exposure Claim Report from HPSO (CNA, 2020) identified many of the same risk factors for malpractice as have been identified for ethical issues. The relationship of course is the expectation of professional behavior that lowers both ethical and liability risk.

Table 5-1Common Factors Related to Ethical Breaches in Conduct

It is helpful to explore each of these factors in a little more depth as they can serve as benchmarks for each of us to use as guideposts to determine our personal ethical risk level.

Personal well-being: One of the most important but most difficult things to do is a self-assessment to determine if our own personal physical and mental health is strong enough to manage the health and well-being of another person. This relates to having clearness of thought, so decision-making is based on logical thought processes using professional standards.

Non-US entry-level PT education: While the physical therapy education is substantially equivalent, the differences between healthcare delivery in the complicated US system and other nations make it more complicated to deliver care if the practitioner is not familiar with the healthcare system. The other situation that results in ethical breaches results from VISA concerns, where the PT may find themselves in circumstances where they are asked to do certain things that they consider doing out of fear of losing the job that is tied to their VISA.

Power gradient pressure: Physical therapists generally did not choose ...

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