py RODUCTION sss aaa “otherapists, ecupational therapist and other health- fessionals provide healthcare to individuals, who cw Mom diseases and disabilities that require longer wer non inthe form of assessment and treatment. Host therapeutic interventions involve procedures where «rapist has to work with the patients for nearly 4 hour vere for months/years, where hands on techniques © ‘mobilization, manipulation, along with ication of electrodes on patient's body or electrotherapy performed. Very often the patientand his family members epee joo much dependent on the therapists with tse and ‘pectations. Sometimes during patient treatments, injury/ aaeerne. may take place leading to medicolegal sue To aor eid expectations and to avold medicolegs! isn it aaa scntil that the therapists follow an ethical behavior and ss thow no sympathy to the patient/fam ‘members, sno sibit empathy, for proper delivery of therapeutic services. MEDICOLEGAL ISSUES ARISING DURING PATIENT “TREATMENTS. Malpractice During treatment if any adverse ‘effects/complications arise, aon ee are Bee ctan and i sae ca by die eeatiommaeese i= itis regarded as malpractice: enrenapeborrnntiir = injury/ bum, it may lead to healtheare malpractice liability on the mrning ucraplefelinilansftere Is © 1¢En) pasis to such aaa ine naipractice ability oecurs when he clinician pation relationship ss breached duc t0 Pater injury, and. Teeeriical pring ofa -amalefieenee'.es 40 02 harm to patients are severely breached. Malpractice Liability ‘Nbesitucare provider I subjected to liability malpracie, f during performance ‘of tests and measures and application of wreatment interventions, the patient yah =) dela informed consent was taken from caregivers, The factors increasing healthcare eae Bi nts ability exposure include for patient care Professional Ethics ration agency 4 New Government/Institution/Accredit regulations. Constantly changing healthcare delivery techniques & Litigious nature of the public. @ ‘The broadened scope of practice. % Clinical specialty certification issu by such specialists is considered superior, as compared to nonspecialists, who are sometimes blamed for such treatments. # Using cross trained/multiskilled professionals. 3 Using physiotherapy assistants/ward DoY® © therapy in place of the trained therapists ‘The factors that lead to malpractice liability causing patient injury are: + Professional negligence. Breach of treatment relate Intentional misconduct. ‘> Use of defective equipment. Use of faulty techniques. Liability imposed on the healthcare provider due tonegligent edu, causing injury to patients could Be ¢otprimary ability: Its the legal and financial responsibility a one individual healthcare provider for the negligent conduct by self. eee cu lability: The term vicarious liability sefers ' recat egal and financial responsibility on the clinicions indvectt of another person such as an employes or she ‘ward boy or the students/trainees of physiotherapy res, where the care Ye provide .d contractual promises.EEE section 7: Ethics and Management and Special Techniques in Physiotherapy clinician/the codes of ethics pist should have thorough understanding of Accountability: Itis the acknowledgment and shouldering pplicable to therapists of responsibilities for actions, decisions and policies wit answering for results Confidentiality: Itis the ethical principle of discretion associated with professions such as medicine, where the communications between the professional ang the client (about the clients’ medical condition), Ethics ct to be exhibited by volves A set of principles of right co oral philosophy that professionals, It is the systematizing, defending and recommending concepts of ghit and wrong behavior. rig to Webster's dictio} ethics is a concept that deals with moral issues of good and bad, based on 7 written that guides the norms. Ethics, is the code writt behavior of human beings, in the context of different cultures Types of Ethics 1, Meta ethics: It is the branch of ethics that seeks to understand nature of ethical properties, statements, attitudes and judgments. 2. Normative ethics: It describes a set of questions about, how one should act in his/her day to day activities. 3, Applied ethics: Itis the philosophical examination from a ‘moral stand point of particular issues in public and private lives that are matters of moral judgment. Applied ethics is divided into: = Professional ethics ~ Business ethics ~ Bio ethics = Machine ethics ~ Relational ethics ~ Military ethics = Public service ethics It is understood from above given types, that everywhere led privileged communications are not disclosed tg nybody el 4 Objectivity: The clinician should exhibit strong faith inhigy hor techniques to achieve definite outcomes, Respectfulness: It is the specific feeling of regard to the profession and client to achieve the best outcome, Obedience to law: The professionals should work within the premises of laws, which are rules and guide lines to be observed while delivering professional services, ‘Three dimensions of professional ethies: A professional clinician need to follow 3 "R's such as: 1. Rules and regulations for practice of the profession, 2, Responsibility: Should take responsibility to discharge the professional service efficiently. 3, Respect: Demonstrate respect (0 the profession, professional colleagues, seniors and clients. Code of Ethics ‘The code of ethics is a guide of principles for specific groupof professionals, to help them perform their oles, toknowhow to conduct themselves, and to know how to resolve various ethical issues. It helps the professionals to apply moral and ethical principles to the specific situations encountered by them during practice of professional services. Every professional, whether in medicine, surgery, physiotherapy, occupational therapy, etc., need to follow the code of ethics laid down by the respective professional associations/professional bodies. These codes convey the rights, duties and obligations of the members of the profession. These codes provide the basic framework for ethical judgment of the professional and make him/her aware to realize whatis right/wrong while discharging professional services. starting from professional services such as clinicians, teachers ‘to working in military and public services, oneneed to observe ethics for smooth discharge of duties and responsibilities. Professional Ethics It encompasses the personal and corporate standards of behavior expected from professionals, involved in vocations consisting of counseling and services to others after high educational training. ‘The components and qualities of professional ethics are: @ Honesty: It is a facet of moral character that denotes, positive, virtuous attributes such as truthfulness, straight- forwardness, integrity without lying, cheating or theft. & Integrity: Itis a concept of consistency of actions, values, ‘methods, measures, principles, expectations and outcomes. "The actions are to be performed as a whole, exhibiting the quality of honesty with strong moral principles. 4 Transparency; tis ageneral quality, implemented by set of principles, practices and procedures, which allows citizens Professional Association/Professional Body ‘Aprofessional association (also called a professional body, professional organization, or professional society) is usually ‘a nonprofit organization created to progressively develops particular profession, the interests of individuals engaged in that profession and the interest of the public. This is ‘constituted by a group of people (governing body) from the Jearned occupation, who are entrusted with maintaining control or oversight the legitimate practice of the occupation safeguarding public interest. It acts as the controlling body of the learned profession, The members of such bodies aoonibility to various information about procedures are the individual professionals. Some professionsl bodies adapted. / have regulatory power on its members and it is mandatoryvs to reeister with such bodies For example Medical Commission is professions {ots members, the medical practitioners nat {ate equired 0 reesterwiththecouncittopraens {wos The Rehabilitation Council of indiy (Rep, cal ot Where rehabilitation personnel like esoxthotists 8F@ Fequled to register wi this fe ing practice in India, vai OM gherapists working in the country, the Indian «ot Physiotherapists TAP) isthe professional body cootheraists atpresent, where isnot mandatory ; ‘ng i the country, Process of the houses of \erapy Council Ph the association for practic evel Counel for the profession ish the tion, Which has Rot approval from both son cat the country. Once stich Phystoth ‘ost will have a SHONG Controlling power on Its “oss wo have to register withthe counel for pradicing country State Level Counetts are geting formed 1 sssatesofTna to regulate practic of Physiotherapist) savional therapis scons of professional bodies inehide the following ‘ei and assess professional examinations, movide support for Con luing Professional Development muh learning opportunities and toolsforecording and. sinning publish professional journals or magazines, provide networks for professionals to meet and discuss it field of expertise. Jssue Code of Conduct to guide professional behavior Dealwith complaints against professionals nd implement cisciplinary procedures. Seenabling fairer access to the professions, so thatpeople ‘rom all backgrounds can become professionals, Provide careers support and opportunities for students, graduates and people already working. ® Promote research in the particular field, India, two types of professional bodies exist such as: Constitutional bodies: These are bodies that derive ts authority from constitution. They are those bodies which find considerable mention in the constitution, in ‘ways like having a part of the constitution or an article ‘xplaining thetr position. Example: lection Commission of india * Non- constitutional bodies/Extra constitutional bodies: “ra constitutional bodies derive their authority by alaw created by the parliament, an ordinance promulgated by the president or an executive order. They are those bodies hich do not find mention in the constitution. They are ‘Created by various methods which further explain their Nomenclature, The extra constitutional bodies are of two ‘ypes such as: : }, Statutory body: They are those bodies which are created by a law passed by the parliament which explicitly mentions the objectives for creation, their oe ee . Chapter 34: Professional Ethics Eat, Composition, powers, ete, Example: Information Convmision of nd, Rehabiltation Council of India, National Medical Commission, ete Executive hody: They are those bodies which are Created by an executive order, i., order of a ministry of union or state oF registered with the Government Such bodies have no constitutional or law backing them. Example: The Planning Commission of India (A government organization), Indian Association of Physiotherapists (A registeed body) International Professional Bodies World Confederation of Physiotherapy 1¢ World Confederation for Physiotherapy (WOPT) was founded in 1951. It is the sole international voice for Physiotherapists, The confederation operates as a nonprofit Organization and is registered as a charity in the United Kingdom. ‘World Confederation for Physiotherapy is committed to take the profession ahead, and improve global health through: * Encouragement of high standard of physiotherapy education, practice and research across the globe. * Supporting exchange of information among member organizations. * Collaborating with national and international organizations, ‘As WCPT was established on September 8, every year, on this date, World Physiotherapy Day is celebrated. World Health Organization ‘The World Health Organization (WHO) is a specialized agency of the United Nations, responsible for international Public health. It was founded on April 7, 1948, and has its, headquarters in Geneva, Switzerland. It is an international professional body, which plays an essential role in the slobal governance of health and disease, due to its core slobal functions of establishing, monitoring and enforcing international norms and standards, and coordinating multiple actors toward common goals. Every year April 7 is celebrated as World Health Day. The work of the WHO is defined by its Constitution, which divides WHO's core functions into three categories. * Nonmnative functions, including intemational conventions and agreements, regulations and nonbinding standards ‘and recommendations. * Directing and coordinating functions, includin, gitshealth forall poverty and health, and essential medicine activities and its specific disease programs. * Teearc canatechnical cooperation functions, including dieu erection and emergency snes UNICEF UNICEF, known as United Nati iden’ anagency of United ed Nations Children’s Fina, is fons, responsible for provid humanitarian and devetopmnentat hlldren we tdwide: Mreomzed aoe wid sreadcocutenre eteO_O in the World, tras found on December 1th, 1946, 1h New York, United States, as its headquarter Functions of UNICEF The main funetion of UNICRE includes the © Providing immunization and dise cehidvon © Administering. te affected by IV & Strongthening child, ehildhood and maternal nutrition, & Innproving sanitization, Providing emergeney tell in response to disasters atlovving prevention to ont for children and thelr mothers, Positive rotes of code of ethies: The codes of etliles lald down by professionals axsociations/organtzations work as a protective cover highlighting the boundaries within whleh a professional should work, It guides the professional (0 works without damaging self, the profession and the ellents, ‘the codes of etiies have some positive roles stich as: © Inspiration: Fthical codes provide a positive to professionals for discharging their professtonal d efficiently and honestly, exercising the obligations. % Guidance: Ethical codes provide the guide achieving success in professional matters. ‘S Support for responsible conduct: The ethical codes provide positive and potential support to the professional to practice a particular profession efficiently within ethical manner, * Education and promotion of mutual understanding: ‘The codes of ethics help in emphasizing the importance ‘of moral issues in values among teachers and students, in educational institutions and promote mutual understanding to resolve professional issues, Contributing to a positive public image of the profession: The codes of ethics promote cre ofa particular profession, whose members are committed to provide service with dignity, taking accountability for their actions. ‘* Promoting business interests: The codes of ethics promote business interest by charging fees for professional services, which the client can afford to, considering the nature of services and period (days/months) for which the services are required, so that discontinuity in getting services by the clients can be eliminated. © Protects the status quo and suppress dissent within the profession: The codes of ethics eliminate disputes within a profession and make the services run smoothly ‘maintaining status quo. 16 for Principles of Professional Ethics + Autonomy: Autonomy of the client/patient to opt for or out of any treatment options should be available to him. Beneficence: Duty of the healthcare provider is to ensure that the client in his/her care is assured of all the benefits, of his/her professional knowledge to help the person ‘overcome the dysfunction, health provider Isto ensure that using nin his/her are, hls involve, _reapect fOr AULONOMY, and thy Mid the correct information to the best of yyy led upon by a court of law, asizen upon doing. ne harm y, 6 junttees Duty of the «to the individ equal duty (0 pro hur knowledge if cal + Non-mateficences [1 empha the patient & Confidentiality: Malnta fo not discuss ane pi jit without the eons i records are not kept ‘ot knowledge: The patient has the righty fat the information pertaining, to his/her condition ang Her ment, He/ahe also has the right 10 change verieg juoviders and treatment procedures I he/she $0 wishes in confidentiality abot the patieny’, en's Condition wi, tof the first party. Prsuge 5 of publle secesg, ETHICS IN PHYSIOTHERAPY. ules in physiotherapy can be defined as the moral ende hf conduct that defines the relationship between the physlotherapistand his/her patient or client, nd the therapi vet other healthcare professionals based on mutual respect and trust itis the legal duty of a physiotherapist, to support the linician or student to provide a “reasonable” standard of care to patients and to protect their safety. ractitioners have a duty to make the care of patients or clients theirfirst concern and to practice safely and effectively, Maintaining a high level of professional competence and conduct is essential for good patient care. The Practitioners have ethical and legal obligations to protect the privacy of people requiring and receiving care, Patients or clients have a right to expect that practitionersand their staff will hold information about them in confidence, unless information is required to be released by law or public jerest considerations. Before applying any intervention, it is essential that, the therapist/clinician explains the patient/caregiver about the tests and measures to be performed and intervention to be applied including the costs of such procedures. After explaining these to the patients/caregivers, he/she should take informed consent from the patient/caregivers (ifthe patient isa small child, very old man or unconscious), expressing the willingness to perform the tests/measures on him/her andto take such treatments understanding the benefits and hazards. Informed Consent Itisa process in which a healthcare provider, educates patient or his/her relative, about the risks, benefits and alternatives ofa given, test and measures and treatment intervention and take his/her (patient’s/relatives) consent to undergo such tests/interventions in a prescribed format designed for the purpose. Itis the duty of the healthcare provider, to make it clear that, the patient has understood the different elemen's ofinformation regardingassessment and treatment, totakea decision about his/her assessment/treatment, and has signedthot YES nm are ra apintery tion tore: vet = wal {re erie ofthe dleonse/disordet: oc ie a finns mentatlon ye na ents of ie vation of the procedure/trentment interventions snmendted vera risks of serious harms/comptications, spected benefits of stich treatment procedh able alternatives availa, a ‘its of alternatives, eae « niskand 5 anol be understood by all that faiture to obt alt patient consent consitneshealtteme meee provessional negligence malpractice litigation, premised ye jackol we be consentis legally actionable onty when the following take place: \ patient injury takes place from an undisclosed tisk « Patient/eare givers complain that, had they known th {uals of sich procedures before hey world aes consented for stich procedures/treatments, here are certain exceptions to obtai consent, sttch a: » Emergency doctrine: Under this, when a patient pres fovevaluation and treatmentsintife-hreateningonerens threatening emer situation, and is unable to communicate. his/her alerts undergo such treatments/procedures, the clinician can siart the intervention without waiting for consent, with presumptions that, the patient/caregiver would consent co such lifesaving interventions, + Therapeutic privilege: Under this, a clinician may be justified in withholding from a patient information, about ‘the patient's diagnosis/prognosis, when in the judgment of the clinician, the patient/care givers cannot deal psychologically with such information, in patient informed | CODE OF CONDUCT FOR PHYSIOTHERAPISTS Physiotherapists, as healthcare providers, are required to follow the code of conduct prescribed for their functioning to avoid medicolegal issues. A few codes of conduct are: © Physiotherapists respect confidentiality, privacy, and security of patient information. + Physiotherapists treat people fairly. * Physiotherapists practice in a safe, competent and accountable manner. + Physiotherapists act with integrity in all professional activities. * Physiotherapists shall provide honest quality care, competentand accountable professional consultancy, and therapeutic services to any person who may seek or may be in need of the same. elie cri Physiotherapists should recognize: oftheir expertise ‘and confine themselves to performing duties for which they ‘are properly educated, trained, and qualified, makingreferrals ‘when situations are outside their area of competence. Chapter 34: Profesional Ethics sss Physiotherapists should not exploit, threaten, peruiade the unwilling to aecept foreofitly, or eeeually hanes others Physiotherapists should refrain from unjustified or unseemly crtieleny of fellow members, other pregrattis anet other ortantvattons Phystatheraphite dhnild take apprnpelate steps tn enhance the eafery and security of patients + Physiotherapiate should prnvide accurate, complete ‘current, andl unbiased information Physiotherapists should reapert the dignity anel ase: laghrs ‘of patients and professional cofleaies + Physiotheraplats choald minke tinely referral af the patient only, I required fo appropriate speetalists, for investigation and treatment if reqiirement arides + Physiotherapists should maintain secreey of rhe patient lagnasis and treatment. and can diselose the same afore professional colleagues, duringease disenssions/serniniars + Physiotherapists are required to explain the patient about the investigations and treatment fo be unelertaken, its potential benefits and dangers, ransonable alternatives available andl take informed consent, before starting such Intervention + Physiotherapists should apply an intervention ro the patient, for which, he/she has expertise Physiotherapists should not accept any gift from patients, intended to influence his/her treatments. Physiotherapists, while treating patients should have 4 feeling of internal kindness (empathy) to the patients rather than showing external kindness. * Physiotherapists in private practice are required to charge reasonably for the services delivered. + Physiotherapists are required to treat patients without any partiality, Le., without considering, whether the patient is rich or poor, except, when especially detailed by the head of department (HOD) to treat a VVIP, and in such a case the therapist should arrange continuation of therapy for the regular patients also. Physiotherapists are required to attend seminars, conferences to get acquainted with the latest developments in the profession. Physiotherapists should participate in outreach services, to provide healthcare to people in the community. * Physiotherapists involved in teaching, should use modern teaching technology and try to clear all doubts of the students. Male physiotherapists treating female patients should ensure that, a female attendant is available in the room during assessment and treatment. Physiotherapists should take appropriate measures for documentation and treatment of complications, ifso arises, * Physiotherapists should take advice of the HOD of the department, if any ethical dilemma arises, ** Physiotherapists should maintain proper documentation of the patients’ ‘records for follow-up and research, *TE Section 7: Ethics and Management ancl Special Techniques in Physiotherapy © Physiotherapists should make a thorough clinical reasoning, to select the appropriate modality/technique % Physiotherapists should make time management to complete the assessment and services in time. © Physiotherapists should not make any among patients and students on the basis of cast, religion, rimination etc 4 Physiotherapist should respond honestly to any enquiry conducted against allegations, and provide accurate information. ‘© Physiotherapists should provide high standards of clinical service and teaching to keep the profession at high levels. Physiotherapists involved in class room teaching should present themselves in a respectable manner, + Physiotherapists should work ethically to keep the reputation of the profession, department, and institute at avery higher position. © Physiotherapists should not make any public statements about the department/institution, except when he is assigned the responsibility to address media. The Code contains important standards for practitioner behavior in relation to: + Providing good care, inclu among patients, care givers an ding shared decision making .d different professionals. * © Working within th Working with patients or ellents co resolve health diab ieattes Working with other practitioners (0 share Kis/hep knowledge for achieving succes jul management of clients, healtheare system, (0 practice, whae he/she has been trained for Minimizing risk by using efficient properly serviced nt and selecting appropriate techniques through, fh clinical reasoning. mnal performance at high standard ional behavior and ethical conduet Ensuring health and wellbeing of the practitioner (setf), Teaching of professionals, supervising services of juniors and assessing the clients’ progress. ae ifferent professional associations/ organizations {indian Association of Physiotherapists, American Physiotherapists Association (APTA), ete:| Rave Jaid down code of ethics for its members. In india Physiotherapists are required to follow the code ofeties laid by IAP (IAP Code of Ethics). The physiotherapisss practicing in India and the students of physiotherapy vre advised to read and follow code of ethics given by — IAP. equipme! ining profession Observation of profess’