Ethics and Morals in Physical Therapy Practice

Foundations of Physical Therapy Clinical Practice Framework

Clinical practice in the United States is guided by a collaborative framework consisting of state physical therapy (PT) boards and the American Physical Therapy Association (APTA) Code of Ethics.

• State Laws: These allow individual state boards to define and enforce the specific practice of physical therapy within their jurisdiction.

• Professional Ethics: These represent the moral standards of practice maintained within the scope defined by a state's practice act.

State Laws and Regulations

Each state maintains its own practice act to define the professional scope. These acts mandate that physical therapists be licensed within that specific state to provide patient care and establish the standards for that licensure. Most practice acts are divided into $2$ distinct sections:

• Laws: Generally established by state boards to define the practice of physical therapy within the specific state.

• Regulations: Issued by the board to help define and clarify the processes and procedures used to enact and enforce the established laws.

Defining Ethics and Morals

The definitions of ethics and morals are foundational to clinician conduct, though their application may be contextual based on the work environment, patient population, and state of licensure.

• Ethics: A branch of philosophy defining what is beneficial for individuals and society. It establishes the nature of duties and obligations people owe to themselves and others. In modern society, it is defined by how individuals, professionals, and corporations choose to interact. Ethics specifically refers to the standards or codes of behavior expected by a group (e.g., national, social, company, professional, or family ethics).

• Morals: These are personal or professional characteristics. While a person's moral code is typically unchanging, the ethics they practice can be dependent on others or the specific context of their group.

• Relationship: Ethics represents the system in which individual morals are applied.

The APTA Code of Ethics

The American Physical Therapy Association provides a Code of Ethics that serves as the guiding principles for the profession. This code is built upon $5$ key areas of physical therapy practice:

• Patient management

• Consultation

• Education

• Research

• Administration

The structural foundation of the Code of Ethics includes $8$ principles and $7$ core values. These values shape the profession and define the ethical obligations of all physical therapists as described by the APTA.

The Seven Core Values

1. Accountability

2. Altruism

3. Compassion and caring

4. Excellence

5. Integrity

6. Professional duty

7. Social responsibility

Professional Negligence and Malpractice

Professional negligence or malpractice occurs when the care provided falls below the standard of care established by competent, skilled physical therapists and results in harm to the patient. To successfully claim malpractice, a plaintiff must establish all $4$ elements of the tort (civil wrongdoing):

1. Duty: The physical therapist had a duty to provide care in a competent manner.

2. Breach: The physical therapist breached that duty.

3. Causation: The breach of duty directly caused an injury.

4. Damages: The injury resulted in subsequent damage.

All $50$ states have specific laws regarding negligence and malpractice. If negligence is determined, the plaintiff can seek different types of damages.

Categories of Damages

• Compensatory Damages: Cover economic and non-economic losses.

  • Economic: Financial losses including loss of wages, medical expenses, and life care expenses (assessed for both past and future losses).

  • Non-economic: Assessments for the injury itself, including physical and psychological harm (e.g., loss of vision, loss of a limb or organ, reduced enjoyment of life due to disability, loss of a loved one, severe pain, and emotional stress).

• Punitive Damages: Awarded only in cases of wanton and reckless conduct.

• Historical Context: During a tort reform in the early $1980s$, many states enacted statutory damage caps on personal injury cases.

Whistle-Blowing and Mandatory Reporting

Practicing physical therapists have a legal and ethical obligation to report illegal, unethical, or incorrect activities.

• Whistle-blowing: The act of reporting activity deemed illegal, unethical, or incorrect.

• Mandatory Reporting: All $50$ states have specific guidelines identifying mandatory reporters for suspected patient abuse or violence.

Reporting Procedures and Requirements

• Process: Often defined in state practice acts. Typically involves an initial telephone call to report, followed by a written report. This initiates an investigation aimed at protecting the individual.

• Joint Knowledge: If $2$ or more required reporters are present and have joint knowledge or suspicion of violence, both must report, and there should be agreement within the reporting system.

• Required Information for Reports:

  • Name of the injured person.

  • Current whereabouts of the injured person.

  • Character and extent of the person's injuries.

  • Identity of any individual the injured person alleges inflicted the injury.

The RIPS Model of Ethical Decision Making

As autonomous practitioners, physical therapists must balance workspace demands with the need for ethical, comprehensive care. The RIPS model provides a structured framework for analyzing ethical cases:

1. Recognize and Define: Identify the ethical issue at hand.

2. Reflect: Analyze the situation and its implications.

3. Decide: Determine the necessary course of action.

4. Implement, Evaluate, and Reassess: Carry out the decision and review the outcomes.