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 dem- onstrating 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 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 satisfac- tory 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 often felt constrained in their ability to manage it as they did not have the primary responsibility for the situation. The proliferation of direct access states to our current 50 plus the District of Columbia and the change of PT education to the 2017 CAPTE requirement that all programs be at the Doctor of Physical Therapy education level creates a very different professional landscape. 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, this demands that each clinician is accountable for their professional actions. The concept of professional ownership is discussed in more detail in Chapter 3.
THE ETHICAL DECISION-MAKING PROCESS
Ethical decision-making is a challenge to physical therapy professionals, who face both an increase in the number of 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 ...