Ethical Principles and

Ethical Decision Making

in Physiotherapy
 members

A
Fatemeh 20235686

Reem 20234873

Zahra 20234030

Saleh 20223519

Nnete 20234744

Eghbal 20236112
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Ethics principles
Fatemeh
 Introduction
For good ethical clinical decision making, healthcare practitioners should
utilise a good knowledge of basic ethics which includes an understanding
of the underlying basis for ethical principles such as respect for autonomy
and justice, as well as a reflective knowledge of the influence that one's
personal beliefs and values might exert in the decision-making process.

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 The Four Principles, originally devised over 30 years ago by Beauchamp
and Childress in their textbook Principles of Biomedical Ethics[3], are
considered by many as the standard theoretical framework from which to
analyse ethical situations in medicine[4].

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 Four principles of medical ethics:
Autonomy – The right for an individual to make his or her own choice.
Beneficence – The principle of acting with the best interest of the other in mind
Non-maleficence – The principle that “above all, do no harm,”
Justice – A concept that emphasizes fairness and equality among individuals.
[5][6]

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 History of ethics
People became aware of the need to make a philosophical-moral
reflection on the new possibilities open to the biological and medical
sciences in full after the Second World War, in the course of which the
latest medical accomplishments were used in the genocide of millions of
people. [2]

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 Religion and law
If we would base our professional ethical judgement only on the moral
values stated by the religion we might belong to, we could get in trouble
when professionally justifying our decision. This could be because of the
issue that some of the religious convictions might concurrent with
professional codes of conduct or ethical principles or human rights in
general.

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Reem
 A patient has the right to respectful care given by competent workers. A
patient has the right to know the names and the jobs of his or her
caregivers. A patient has the right to privacy with respect to his or her
medical condition. A patient's care and treatment will be discussed only
with those who need to know. The right to informed consent about the type
of treatment you will receive and your treatment options. The right to give
permission before treatment or refuse treatment you are not comfortable
with. The right to be asked for and give your ongoing agreement for the
care plan.

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 World Physiotherapy expects physiotherapists to
follow these ethical principles:
1. respect the rights, personal dignity, privacy and autonomy of all individuals
2. comply with the laws and regulations governing the practice of
physiotherapy in the country in which they
practise and the policies of their professional associations and regulatory bodies
3. accept responsibility for the exercise of sound professional judgement
4. provide honest, competent and accountable professional services

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 5. provide fair, equitable, inclusive and quality services
6. charge and receive a just and fair level of remuneration for their services
7. provide accurate and appropriate information to patients/clients,* to
other agencies and the community
about physical therapy
8. contribute to the planning and development of services which address
the health needs of the commu

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 Ethical barriers can arise between patients and
physical therapists:
1. Confidentiality: Physical therapists must maintain patient confidentiality, but sometimes
patients may disclose sensitive information that could pose risks if shared without consent.
2. 2. Boundary issues: Maintaining professional boundaries is crucial, as blurred lines can
lead to ethical dilemmas, such as inappropriate relationships or conflicts of interest.
3. 3. Informed consent: Ensuring patients fully understand their treatment options, risks,
and benefits is essential. Failure to obtain informed consent can lead to ethical issues
regarding autonomy and self-determination.
4. Competence: Physical therapists must provide care within their scope of practice and
expertise. If a therapist lacks the necessary skills or knowledge, it can compromise patient
safety and raise ethical concerns.

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 5. Cultural competence: Understanding and respecting cultural differences is essential in providing
effective care. Ignoring or disrespecting a patient's cultural beliefs or practices can lead to ethical
challenges.
6. Dual relationships: Physical therapists should avoid engaging in dual relationships with patients,
such as becoming friends outside of the therapeutic relationship, to prevent conflicts of interest and
maintain professionalism.
7. Truthfulness: Being honest and transparent with patients about their condition, prognosis, and
treatment options is crucial. Misleading or withholding information can lead to ethical dilemmas
and erode trust.
8 .Professionalism :Upholdingprofessional standards of conduct, including honesty, integrity, and
accountability, is essential in maintaining the trust and confidence of patients.

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Saleh
 Introduction
Components of the Bill of Rights of Physiotherapy PatientsThe right to
respectThe right to justice and to avoid discriminationThe right to receive
and access informationThe right to choose and make decisionsThe right
to receive quality services and health educationThe principle of
confidentialityThe right to complain and resolve it

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 The patient has the right to be treated with respect when receiving
physiotherapy services, and having a behavior that preserves their dignity
and human dignity is the right of every patient.
1- The patient has the right to listen to his words in order to express the
history of his illness, disorders, disabilities and problems related to
physiotherapy.
2-The patient has the right to be treated gently, patiently and kindly.
3- The patient has the right to be treated with respect for his criticism of
inappropriate physiotherapy services.

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 4- Patients have the right to respect their beliefs and opinions of any
ethnicity, religion, nationality, race and culture.
5- The patient has the right to die in peace and with dignity.
6- The provision of physiotherapy services should be based on justice and
equality, and thisThe patient has the right to receive sufficient, correct and
appropriate information about his illness, disorders, disabilities,
physiotherapist and physiotherapy methods.

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Zahra
 Ethical Decisions
Today people face more ethical decisions that they did just five years ago.
Whether they are confronting them more, they are recognizing them
more, or they need to accept more responsibility for them individually is
not known, but people definitely deal with more ethical issues Ethical
Infancy

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 Physical therapy is considered to be in its ethical infancy.Ethical decision making
is a very mature professional ability and as a profession, our maturity is evolving.
Physical therapists have not had an opportunity to make independent, autonomous
ethical decisions over the long run. We often look to professional codes for
guidance; however, it has been said that professional codes do not help manage
daily dilemmas. The privilege and influence accompanying autonomous practice
obligates physical therapists to look beyond both the literal and superficial
interpretations of their ethical code, and to consider the complexities of ethical
issues that are evident in the current practice

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 Determinants of Ethical/Moral Behavior
There are basically four components to moral behavior - moral sensitivity,
moral judgment, moral motivation and moral character. For a good ethical
decision to be made, all four of these components have to be in place. None
is more important than the other. All four of them have to be in place to
meet the "rotator cuffs" of ethical decisions.Moral SensitivityMoral
sensitivity is the ability to interpret the situation and project the
consequences of your actions. If you do not have moral sensitivity, then
you do not act ethically because it does not occur that what you are doing is
going to affect anybody else.

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 Moral Judgment
Moral judgment is deciding which action is right or wrong because you
are able to assess how the different lines of actions that you could take
will affect other people.Moral MotivationMoral motivation prioritizes
moral values over motives such as self gratification, making money,
revenge, protecting your reputation or protecting your organization.

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 Moral Character
This is the ability to have the perseverance, the toughness, the conviction
and the courage to take action to correct something that you know is wrong.
This is taking on the duty to report even if you are not required to report. It
is truly the essence of professional behavior. This is the standard that we
need to achieve. We need to help people understand that it is their
responsibility to stop acuons at ment be negative for Moral Failure
Moral failure occurs when any of these components do not happen. In order
to take moral action, you have to have all four of them. It is a complex
interaction.

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 Nnete
ETHICAL DECISION MAKING IN PHYSIOTHERAPY
 What is ethical decision making in
physiotherapy?
Ethical decision making is whereby the physical therapist must be
allowed to make decisions on patient and client car in accordance with
their clinical judgment .Ethical decision making includes recognizing the
ethical situation and making professional judgment it also includes the
basic ethical values like professionalism, responsibility, fairness, integrity,
respect for patients/ clients, dignity and autonomy

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 In the code of ethics
It states that physical therapists shall be accountable for making sound
and professional decisions. In addition there is a lack of knowledge about
knowledge about the way physiotherapy around the world learn about
professional code of ethics and ethical decision making frameworks. The
profession has a gap in the understanding about physiotherapist views on
factors that play a role in ethical decision making and whether these
views differ between world physiotherapy regions.

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 Methods
An online survey study in English was conducted from October 2018 to
October 2019. Participants included 559 physiotherapists located in 72
countries. The self-designed survey questionnaire contained 13 items
asking about demographic information and means of learning about ethical
codes and decision-making frameworks. A further 30 items were presented
which included statements underpinned with individual, organisational,
situational and societal factors influencing ethical decision-making.
Participants were asked to express their level of agreement or disagreement
using a 5-point-Likert-scale.

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 Conclusion
Multiple factors play a role in physiotherapists’ ethical decision-making
internationally. Physiotherapists’ ethical knowledge is informed by, and
acquired from, several learning sources, which differ in both quality and
quantity amongst World Physiotherapy regions. Easily accessible knowledge
and education about professional codes of ethics and ethical decision-making
can foster continuing professional development for physiotherapists. The
establishment of constructive ethical cultures in workplaces can improve ethical
decision-making, and should acknowledge the influence of individual,
organisational, situational and societal factors. The establishment of
collaborative learning environments can support knowledge translation which
acknowledges practice-based methods of knowing and learning.

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 Eghbal
Analysis in the ethical decision-making of physiotherapist students, through case-based learning
 Introduction
Training in ethical competencies is perceived with special interest among
the objectives of health education. The dimensions of the person such as
integrity, autonomy and dignity influence the choice of interventions, but
the different specialties of the health sciences conceive these dimensions
with different perspectives depending on the clinical setting. These
divergences can be detected during the first years of undergraduate
studies, and it is important to know the professional bias and its possible
causes.

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 Materials and Methods
A procedure was developed through case-based learning (CBL) to assess various
characteristics of decision-making during the early stages of student training. A
semi-quantitative method was designed based on the narrative responses of a case
with ethical implications in the field of gender violence. The method was applied to
294 undergraduate students in nursing (95), physiotherapy (109) and dentistry (90)
from the Faculty of Health Sciences of a Spanish university. A frequency analysis
of the narrative responses of the students to the proposed case was carried out,
using the chi-square test to determine any association between the variables
studied: gender, specialty and ethical knowledge.

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 Results
Four types of response categories were detected, as a result of combining
the personal conversation, report to legal authority or require assistance of
other teams. The most common option in dentists is conversation only,
while physical therapists include the assistance of other teams. In nursing, a
balance is observed between both possibilities. The results show that
student responses differ significantly among specialties and also differ
significantly according to test scores on ethical knowledge. However, no
significant differences were found between the responses provided by men
and women.

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 Conclusion
Most of the health sciences students highly valued their own capacity for
dialogue and reflection to approach situations with complex ethical
dimensions. We consider that case-based learning (CBL), in combination
with narrative analysis is a valid means of evaluating the professional
ethical competencies of students in health sciences careers applied to a
common goal.

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 Only 8% of physiotherapy students would propose the exclusive personal
conversation option as the initial approach, a figure much lower than among the
dental students. In addition, physiotherapy students (both male and female) were more
likely to combine personal conversation with other alternatives, and in fact, 44.2%
proposed consulting a team of psychologists as an additional measure. This may
suggest less trust in the effectiveness of personal dialogue and greater confidence in
the effectiveness of psychological therapy or the legal system.54, 55 Ethics is not
widely taught in physiotherapy degrees, mostly due to course content structure, which
may lead to limited teaching efficacy.55, 56 Thus, our findings may reflect some of
these curriculum deficiencies in this group of students.41

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 References PART1

1.Corts TE. The Derivation of Ethos, Speech Monographs Journal. 1968;35(2):201-202

2.Polskie Towarzystwo Tomasza z Akwinu. http://www.ptta.pl/pef/haslaen/b/bioethics.pdf
3.Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th edition. New York: Oxford University Press, 2001
4.Adrian Aldcroft. Measuring the Four Principles of Beauchamp and Childress. BMC Series blog
5.Page K. The four principles: Can they be measured and do they predict ethical decision making?. BMC medical ethics.
2012;13:10.
6.Varkey B. Principles of clinical ethics and their application to practice. Medical Principles and Practice. 2021;30(1):17-28.
7.Westra AE, Willems DL, Smit BJ. Communicating with Muslim parents:“the four principles” are not as culturally neutral
as suggested. European journal of pediatrics. 2009;168(11):1383-7
8.Dinges St., Ethische Entscheidungskulturen - Hindernis oder Unterstützung am Lebensende, Palliative Care, ed. C
Knipping. Bern 2006, Verlag Hans Huber

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 Reference PART 2

• Addressing these ethical barriers requires ongoing education, self-reflection, and adherence to ethical codes
and guidelines within the field of physical therapy.

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 Reference PART3

• Iran Physiotherapy/Physiotherapy Blog Manager: Ebrahim Barzkar (Physiotherapist/Senior in Psychology)

Evaluation of patients-physiotherapy-movement therapy

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 Refernece PART5

• Reference https://archivesphysiotherapy.biomedcentral.com/

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 Reference PART 6 First published:
• 04 June 2021 https://doi.org/10.1111/eje.12700

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Thank you