Subject: Professional Issues 03

Topic: Module 2

OUTLINE ethics is integral to professions like physical therapy.

I. LESSON 1-2 What are professions? In a loose sense, professions
A. PHYSICAL THERAPY AS A PROFESSION include all ways of making a living: thus, professional
a. ADVANCED EXPERTISE athletes, spies, and even murderers.
b. INDEPENDENT JUDGMENT
c. SOCIAL ORGANIZATION Professions meet four criteria: advanced expertise
d. COMMITMENT TO THE PUBLIC and education, independent judgment, social
GOOD
organization and recognition, and commitment to the
B. CODE OF ETHICS
C. PT AS A PROFESSION public good. Accordingly, physical therapy is a
D. PROFESSIONAL ETHICS profession if it meets these criteria, and surely it does.
E. RESOLVING ETHICAL DILEMMAS a. Advanced expertise
a. MORAL REASONS
b. FACTS combines sophisticated practical skills with a strong
c. OPTIONS AND OUTCOMES grounding in sophisticated theory. Stated in another
d. DELIBERATION AND DECISION way, professional expertise combines practical know-
e. ACTION how with “knowing-that” (numerous theory-based
f. REVIEW facts).
F. MORAL REASONING
G. GOOD JUDGMENT b. Independent judgment
H. SAMPLE CASE
implies the need for discretion—in contrast with merely
II. LESSON 3-4
A. WHAT IS AUTONOMY? mechanical or routine procedures—in making
B. AUTONOMY diagnoses of problems, considering alternative
C. PRINCIPLES OF AUTONOMY solutions, and reaching sound verdicts about how to
a. INFORMED CONSENT proceed. Traditionally, so-called “true professionals”
b. VERACITY were said to act independently on their own judgment,
c. CONFIDENTIALITY without supervision by others.
D. PATIENT CARE
c. Social organization
a. HEALTH-CARE PROVIDER AND
PATIENTS
typically includes one national professional society—
b. HEALTH-CARE PROVIDER AND
OTHER PROFESSIONALS
such as the American Medical Association, the
c. HEALTH-CARE PROVIDER AND American Bar Association, and the American Physical
WIDER COMMUNITIES Therapy Association—together with organizations
E. CASE SAMPLES within each state. Social recognition means that the
III. LESSON 5-6 profession, through its professional organization, wins
A. WHAT IS CULTURAL COMPETENCY? support from state and national governments to
B. CULTURE educate, license, discipline, and in other ways regulate
C. COMPETENCE
its membership.
D. INDIVIDUALISTIC CULTURES
E. COLLECTIVIST CULTURES d. Commitment to the public good
F. STAGES OF DEVELOPING
G. CULTURAL COMPENTENCY refers to a shared devotion to some public good or to
H. PREJUDICE OR BIGOTRY some aspect of the good of society.
I. PEOPLE WITH DISABILITIES B. Code of Ethics
a. DISABILITY IS DEFINED IN THREE
DISTINCT WAYS: Provide guidance to professionals for moral dilemmas.
J. SEXISM
a. EARNINGS BY GENDER Establish a fair playing field that reduces cutthroat
K. RACE & RACISM competition.

References: PowerPoint and Recording Give support to professionals who are sometimes
Legend: asked by their employer to "cut" corners in the name
M ain Topic of profit.
Main-Sub Topic
Sub Topic Serves as the official statement by a profession that
Book PPT Side notes Speaker
they are committed to promoting the public good.

Promote public trust

C. PT AS A PROFESSION

I. LESSON 1-2 Theory+ Skill/Practice

A. Physical Therapy as a Profession PT Assessment & Dx
Regardless of how we characterize ethics, clearly PPTA/APTA

Compiled and Transcripted by: Dominic C Castañeda (Riverside College Inc.- Bachelor of Science in Physical Therapy)

Code of Ethics
D. Professional Ethics
Ethical dimensions in professions are needed to:
o Have clear boundaries
o Have commonly accepted norms of behavior
o Enhance respect within and outside the
profession
o Protect the rights of the consumer/ client
o Protect the rights and privileges of the
professional
E. Resolving Ethical Dilemmas
Let us now return to ethical (or moral) dilemmas,
which are situations in which moral reasons come into
conflict. Such dilemmas are commonplace in the
professions, as elsewhere, because moral values are
many and varied and enter into life in innumerable
ways. The following steps are typically involved in
responding to ethical dilemmas.
To further illustrate how these steps apply , please
read Case 1.1 (found at the first Chapter page) in page
9-12 of Physical Therapy Ethics 2nd Edition by Donald
Gabard and Mike Martin
a. Moral Reasons
Identify the conflicting moral reasons that comprise
the ethical dilemma. Moral reasons take many forms.
They include responsibilities (obligations, duties),
rights (both general human rights and specific rights
created by contracts), good and bad consequences,
valuable relationships, ideals, and virtues (good
features of character).
b. Facts
Identify the relevant factual information—relevant in
terms of the moral reasons applicable in the situation.
This includes the applicable laws and policies. Identify
the relevant stakeholders—that is, people and groups
directly affected by how the dilemma is resolved.
c. Options and Outcomes
Identify the realistic options in resolving the dilemma
and their likely outcomes.
d. Deliberation and Decision
Make a reasonable decision by deliberating to discover
the option that most reasonably balances and
integrates the moral reasons. (Occasionally more than
one option can provide a reasonable solution.)
e. Action
Take action; implement your decision.
f. Review
Reflectively review your process, and assess the
outcomes. Look for ways to improve the process by
identifying procedural hurdles or barriers, and assess if
procedural changes are needed for the future.
F. Moral Reasoning
Moral reasoning is a thinking process with the
objective of determining whether an idea is right or
wrong.
To know whether something is "right" or "wrong" one
must first know what that something is intended to
accomplish.
Clinical Competence
o to the capability to perform acceptably those
duties directly related to patient care.
G. Good Judgment
“To choose worthy goals and set proper priorities,
thinking through the consequences of your actions;
and basing your decisions on practical wisdom and
good sense.”
I swear to fulfil, to the best of my ability and
judgment, this covenant:
Conduct myself in a manner which is morally and
ethically sound
H. SAMPLE CASE
Hillary is an in-house PT to a local university; her duties consist
primarily of screening athletes during the preseason and
treating injuries during practice or games. Currently she is
treating Donald, the school’s star wrestler and weight-lifter, for
a minor tear in his biceps brachii tendon. She notices excessive
muscle hypertrophy as the tear heals. Because she knows that
anabolic steroids are a common cause of such problems, she
immediately urges him to stop. But Donald refuses to listen and
at one point he uses threatening tone that makes Hillary feel
her job at jeopardy. In addition, the coach is known to be an
aggressive competitor and lackadaisical about drugs. What
should Hillary do and why?
II. LESSON 3-4
A. What is Autonomy?
MORAL AUTONOMY
o Is the moral authority or right to make one’s
own decisions.
PSYCHOLOGICAL AUTONOMY
o Is the competency to make one’s own
decisions and ability to reason and act
rationally.
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 divulging it to unauthorized persons.
C. Patient Care
RELATIONSHIP-CENTERED CARE
o The Pew-Fetzer Task Force developed such
model: “ The Phrase ‘relationship centered
care’ captures the importance of the
interaction among people as the foundation
of any therapeutic or healing process”

a. PEOPLE REFERS TO: Health-care provider and

A. Autonomy Patients

Medical Paternalism
o View that physicians are justified in
promoting the well being of patients as
defined by the physician, regardless of
whether patient gives prior consent.

Weak Paternalism
o Is interfering with others’ liberty to prevent
them from harming themselves.

Strong Paternalism
o Is interfering with others’ liberty for the
purpose of promoting their good.
B. Autonomy b. PEOPLE REFERS TO: Health-care provider and
Informed Consent other professionals

Veracity

Confidentiality
a. Informed Consent

For patients to give informed consent , 3 conditions

must be met: Information, Voluntariness and
Competence.
o INFORMATION
 Patient must be given relevant
information concerning their
condition and treatment options in a
manner they can understand.
o VOLUNTARINESS
 Patients must be free to make c. PEOPLE REFERS TO: Health-care provider and
decisions without being coerced or wider communities
otherwise manipulated.
o COMPETENCE
 Patients must be sufficiently rational
or competent to understand and
make health-care decisions.
b. Veracity

The duty to tell the truth to patients is also called the

principle of veracity, honesty, or truthfulness.
c. Confidentiality

The duty of confidentiality is the duty to maintain

privacy of information concerning patients by not

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 D. CASE SAMPLE
Muriel Thomas is a 76-year-old widow who, as a consequence
of a fall, had a hip replacement. Her only living relative is a son,
who shows little interest in her. Almost everyone in the
rehabilitation unit recognizes that most of Muriel’s complaints
are not related to the replacement but instead are thinly veiled
attempts to get attention. She complains of various pains that
change location and have no obvious connection to her injury,
surgery, or therapy. Her functional status with a walker is
nearly where it was prior to the accident. Although the
physician and the therapist agree that therapy goals have
almost been achieved and should be discontinued in a week or
so, the physician asks the therapist to make up some kind of
treatment to appease her complaints. The physician states that
the attention will probably make the pains go away, at least
until she is discharged. The physician also states that she will
enter a diagnosis that will allow insurance to cover the therapist
so that no revenue will be lost to the department. The therapist
complied and started administering low levels of ultra- sound to
Muriel’s forearm, the site of her most recent “pain.” Much to the
therapist’s surprise, Muriel asked her directly how this therapy
was supposed to help.
What are the moral issues in this case, and how do you think
they should have been handled?
Andrew Gordon is a 43-year-old contractor who fractured his
right tibia in a fall from a scaffold.25 Mr. Gordon has been
hospitalized for three weeks because the fracture is not healing
quickly. A fever prompts tests that reveal lymphosarcoma, a
cancer likely to be fatal within a year. His physician, Dr.
Hammill, calls Kim Segard, the physical therapist, to say that he
has talked with Mrs. Gordon and they have agreed that Mr.
Gordon would not want to know the truth. The physician does,
however, ask Kim whether Mr. Gordon has said anything
suggesting he would want to know the truth. Kim reports that
he had not. But 10 days later Mr. Gordon does say to Kim, “I
have come to trust your judgment. . . . I’ve tried to cooperate
with the doctors and everyone, but I have a feeling that
something funny is going on that I can’t get at. My wife and Dr.
Hammill are acting strange and that is scaring me. . . . Do I
have cancer or some fatal illness?”
Larry Dulles is a 26-year-old man being treated in physical
therapy for generalized weakness and neurological problems
associated with acquired immunodeficiency syndrome (AIDS).
One day his mother took him to therapy. After his treatment
session, she remarked to his therapist that he did not seem to
be improving. The therapist said, “Well, we don’t always see
dramatic changes with AIDS patients.” Larry’s mother was
previously unaware of his diagnosis.
Ms. Cargill was born with abnormally small kidneys that
eventually gave way, necessitating a kidney transplant.12 She
lives in a sheltered home environment, appropriate for her mild
mental retardation. When she applied to the Oklahoma
University Medical Center, she was told that she was not a
candidate because she probably could not give informed
consent due to her diminished capacity. This judgment was
reached despite the fact that the state of Oklahoma considered
her competent to make all her decisions. It was true that she
was in a supervised living situation, but she held a job and did
all the ordinary things people do, including having a boyfriend.
As her condition worsened, her caseworker reluctantly appealed
to Adult Protection Services to become her legal guardian. That
agency refused, stating that she was competent. Although Ms.
Cargill signed a consent form allowing the hospital to respond
to reporters, following the publicity of her rejection as a
transplant recipient, the hospital ruled that she was not
competent to give that consent.
III. LESSON 5-6
A. What is Cultural Competency?
B. CULTURE
Refers to integrated patterns of human behavior that
include language, thought, communications, actions,
customs, etc.
C. COMPETENCE
Implies having capacity to function effectively as an
individual and an Organization within the context of
cultural beliefs.
D. INDIVIDUALISTIC CULTURES
Focus on Autonomy and Individual Rights.
As a consequence, elements that contribute to
individual security, such as competitiveness and
planning for the future, are very important.
E. COLLECTIVIST CULTURES
Focus on group well-being and interactions.
Communities are marked by their cooperation and
concern with traditions as a mean of perpetuating the
past into present and future.
F. STAGES OF DEVELOPING CULTURAL
COMPENTENCY
STAGE ONE
o Develop knowledge of self and how one’s self
is influenced by one’s culture and beliefs.
STAGE TWO
o Develop awareness of people who have their
own values, and willingness to treat others as
they wish to be treated.
STAGE THREE
o Develop the ability to empathize with and to
respect individuals having different
worldview.
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 G. STAGES OF DEVELOPING CULTURAL
COMPENTENCY
Is the strongest obstacle to multicultural appreciation.
Although prejudice can involve prejudging someone
favorably but the greater threat to justice occurs when
people prejudge negatively.
H. STAGES OF DEVELOPING CULTURAL
COMPENTENCY
PEOPLE WITH DISABILITIES
K. RACE & RACISM
In practice, race, as most commonly used is defined
by skin color, hair texture and other appearance
variables.
Many scientists are now convinced that the idea of
biologically different races - dividing the one human
race – is a product of racism.

The problem with this language is that

it is not accurate; the person is not

the characteristic.
I. PEOPLE WITH DISABILITIES
In addition, this language reinforces the limiting
perspectives that a stigmatizing “mark” taints all other
characteristics of a person
a. DISABILITY IS DEFINED IN THREE DISTINCT
WAYS:

First, persons are disabled if they have a physical or

mental problem that substantially limits a major life
activity.

Second, all individuals who have been substantially

limited in the past are covered.
Third, inclusion extends to situations where a problem
is created by the attitudes of others.
J. SEXISM
The bias against women might be the most systematic
bias in society because it is prevalent in every aspect
of life.

Historically, women “were expected to be continually

dependent upon men -upon fathers in childhood, on
husbands as adults and on sons in old age.
a. EARNINGS BY GENDER

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