ETHICS AND PROFESSIONALISM

ETHICS AND PROFESSIONALISMPhysiotherapyDefine?Treated age groups?Specialities?Non-patient care roles?Education level?

History of physiotherapyIn 460 BC Hippocrates and Hector ,later GalenusFirst practioners of physical therapy.Used massage and hydrotherapy.18th century orthopaedic developedGymnasticons and exs developed to treat gout1813 , Per Henrik Ling,(father of Swedish gymnastics)Found Royal central institute of gymnastics (RCIG),for massage ,exs and manipulationSjukgymnast someone involved in gymnastic, for those who are ill.

1887 PTs official registration by Swedish National Board of Health and Welfare.1894 4 nurses, formed Chartered society of physiotherapy.1913 school of physiotherapy established by university of Otago in New Zealand1914 Reed college in PortlandThese are the examples of institution that taught PT, they graduated Reconstruction AidesEnd of 19 century modern physical therapy was established.American ortho surgeons,started to treat children with disability, employed women(trained in physical education ,massage and exs)Promoted during polio outbreak in 19161917-1918 (1st world war) therapy performed widely and called as Rehabilitation therapyPeople were named as Reconstruction Aide.

First school of physiotherapy at Walter reed Army Hospital at Washington DC was formed as the out break of 1st world war .1921 first physical therapy research was published in PT Review.1921- Mary Mc Milan (physical therapy aide)formedAWPTA........later called as APTA(American Physical Therapy Association)Mother of Physical therapy due to her contribution.

1924 the Georgia Warm Spring foundation promoted physical therapy in the treatment of polio.1940s main physio practice was massage, traction and exs.1950s manipulation for spine practisedMoved beyond hospitals1974 ortho speciality in physio was formed in APTAInternational Federation of Orthopaedic Manipulative therapy was established, Manual therapy popularised1980s further development in physio was recordedTherapies involved are:US therapy / Exercise therapySWD / Wax therapy IFT / Cryotherapy TENSStimulationsLaserIRRETHICSThe branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions. MEDICAL ETHICSMedical ethics is a system of moral principles that apply values & judgement to the practice of medicine.Physical therapists and physical therapist assistants should strive to apply principles of altruism, excellence, caring, ethics, respect, communication and accountability in working together with other professionals to achieve optimal health and wellness in individuals and communities.

Values in Medical Ethics Six of the values that commonly apply to medical ethics :

Autonomy- the patient has the right to refuse or choose their treatment. Beneficence - a practitioner should act in the best interest of the patient. Non-maleficence- "first, do no harmJustice- concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).Dignity- the patient (and the person treating the patient) have the right to be treated with dignity.Truthfulnessandhonesty-

11Code of ethics for PTPrinciple #1: Physical therapists shall respect the inherent dignity and rights of all individuals. (Core Values: Compassion, Integrity) 1A. Physical therapists shall act in a respectful manner toward each person regardless of age, gender, race, nationality, religion, ethnicity, social or economic status, sexual orientation, health condition, or disability. 1B. Physical therapists shall recognize their personal biases and shall not discriminate against others in physical therapist practice, consultation, education, research, and administration.

Principle #2: Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients/clients. (Core Values: Altruism, Compassion, Professional Duty) 2A. Physical therapists shall adhere to the core values of the profession and shall act in the best interests of patients/clients over the interests of the physical therapist. 2B. Physical therapists shall provide physical therapy services with compassionate and caring behaviors that incorporate the individual and cultural differences of patients/clients. 2C. Physical therapists shall provide the information necessary to allow patients or their surrogates to make informed decisions about physical therapy care or participation in clinical research.2D. Physical therapists shall collaborate with patients/clients to empower them in decisions about their health care. 2E. Physical therapists shall protect confidential patient/client information and may disclose confidential information to appropriate authorities only when allowed or as required by law. Principle #3: Physical therapists shall be accountable for making sound professional judgments. (Core Values: Excellence, Integrity) 3A. Physical therapists shall demonstrate independent and objective professional judgment in the patients/clients best interest in all practice settings. 3B. Physical therapists shall demonstrate professional judgment informed by professional standards, evidence (including current literature and established best practice), practitioner experience, and patient/client values.

3C. Physical therapists shall make judgments within their scope of practice and level of expertise and shall communicate with, collaborate with, or refer to peers or other health care professionals when necessary. 3D. Physical therapists shall not engage in conflicts of interest that interfere with professional judgment. 3E. Physical therapists shall provide appropriate direction of and communication with physical therapy assistants and support personnelPrinciple #4: Physical therapists shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, research participants, other health care providers, employers, payers, and the public. (Core Value: Integrity) 4A. Physical therapists shall provide truthful, accurate, and relevant information and shall not make misleading representations. 4B. Physical therapists shall not exploit persons over whom they have supervisory, evaluative or other authority (eg, patients/clients, students, supervisees, research participants, or employees). 4C. Physical therapists shall discourage misconduct by health care professionals and report illegal or unethical acts to the relevant authority, when appropriate.

4D.Physical therapists shall report suspected cases of abuse involving children or vulnerable adults to the appropriate authority, subject to law. 4E. Physical therapists shall not engage in any sexual relationship with any of their patients/clients, supervisees, or students. 4F. Physical therapists shall not harass anyone verbally, physically, emotionally, or sexually. Principle #5: Physical therapists shall fulfill their legal and professional obligations. (Core Values: Professional Duty, Accountability) 5A. Physical therapists shall comply with applicable local, state, and federal laws and regulations. 5B. Physical therapists shall have primary responsibility for supervision of physical therapist assistants and support personnel. 5C. Physical therapists involved in research shall abide by accepted standards governing protection of research participants.

5D. Physical therapists shall encourage colleagues with physical, psychological, or substance-related impairments that may adversely impact their professional responsibilities to seek assistance or counsel. 5E. Physical therapists who have knowledge that a colleague is unable to perform their professional responsibilities with reasonable skill and safety shall report this information to the appropriate authority. 5F. Physical therapists shall provide notice and information about alternatives for obtaining care in the event the physical therapist terminates the provider relationship while the patient/client continues to need physical therapy services.

Principle #6: Physical therapists shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and professional behaviors. (Core Value: Excellence) 6A. Physical therapists shall achieve and maintain professional competence.6B. Physical therapists shall take responsibility for their professional development based on critical self-assessment and reflection on changes in physical therapist practice, education, health care delivery, and technology. 6C. Physical therapists shall evaluate the strength of evidence and applicability of content presented during professional development activities before integrating the content or techniques into practice. 6D. Physical therapists shall cultivate practice environments that support professional development, lifelong learning and excellence.Principle #7: Physical therapists shall promote organizational behaviors and business practices that benefit patients/clients and society. (Core Values: Integrity, Accountability) 7A. Physical therapists shall promote practice environments that support autonomous and accountable professional judgments. 7B. Physical therapists shall seek remuneration as is deserved and reasonable for physical therapist services. 7C. Physical therapists shall not accept gifts or other considerations that influence or give an appearance of influencing their professional judgment7D. Physical therapists shall fully disclose any financial interest they have in products or services that they recommend to patients/clients. 7E. Physical therapists shall be aware of charges and shall ensure that documentation and coding for physical therapy services accurately reflect the nature and extent of the services provided. 7F. Physical therapists shall refrain from employment arrangements, or other arrangements, that prevent physical therapists from fulfilling professional obligations to patients/clients.

Principle #8: Physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally. (Core Value: Social Responsibility) 8A. Physical therapists shall provide pro bono physical therapy services or support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured. 8B. Physical therapists shall advocate to reduce health disparities and health care inequities, improve access to health care services, and address the health, wellness, and preventive health care needs of people.

8C. Physical therapists shall be responsible stewards of health care resources and shall avoid overutilization or underutilization of physical therapy services. 8D. Physical therapists shall educate members of the public about the benefits of physical therapy and the unique role of the physical therapist.

Key Ethical PrinciplesPrinciple of beneficencePrinciple of the common goodPrinciple of distributive justicePrinciple of double effectPrinciple of formal and material co-operationPrinciple of human dignityPrinciple of informed consentPrinciple of integrity and totalityPrinciple of proportionate and disproportionate meansPrinciple of religious freedomPrinciple of respect for autonomyPrinciple of respect for personsPrinciple of stewardshipPrinciple of subsidiarityPrinciple of tolerationPrinciple of beneficenceTraditionally understood as the "first principle" of morality, the dictum "do good and avoid evil" lends some moral content to this principle.

The principle of beneficence is a "middle principle as it is partially dependent for its content on how one defines the concepts of the good and goodness. The Principle of Nonmaleficence, as "first, do no harm," is often considered to be a corollary to the principle of beneficence. In this respect, it shares the same characteristics of beneficence and is considered as a middle principle. Considered in its own right, nonmaleficence is sometimes interpreted to imply that if one cannot do good without also causing harm, then one should not act at all (in that particular circumstance)nonmaleficence not simply as "doing no harm," but as "doing no evil," which is closer to its etymological rootsPrinciple of the common goodsIn general, the common good consists of all the conditions of society and the goods secured by those conditions, which allow individuals to achieve human and spiritual flourishingthe principle of the common good is corollary to principle of subsidiarity. According to this understanding, the principle of the common good has three essential elements: 1) respect for persons; fundamental rights2) social welfare; (access to basic goods such as cloth,food,medical,work and education)3) peace and security. (public authority should ensure the security of the society and its individual members)Principle of distributive justiceDistributive justice requires that everyone receive equitable access to the basic health care necessary for living a fully human life as there is a basic human right to health care.Benefits and burdens should also be distributed in a just manner.Principle of double effectDouble effect refers to two types of consequences which may be produced by a single action,[7] and in medical ethics it is usually regarded as the combined effect of beneficence and non-maleficence.[8]A commonly cited example of this phenomenon is the use of morphine or other analgesic in the dying patient.[9] Such use of morphine can have the beneficial effect of easing the pain and suffering of the patient, while simultaneously having the maleficent effect of hastening the death of the patient through suppression of the respiratory system.

Examples of double effect ; Administering vaccine (medical)Pregnancy and abortionIn war(bomb)Principle of formal and material co-operationMoralists have long recognized that under many circumstances, it would be impossible for an individual to do good in the world, without being involved to some extent in evil.the principles of cooperation are actually a constellation of moral criteria:Formal co-operationImmediate material co-operationMediate material co-operationFormal Cooperation. Formal cooperation occurs when a person or organization freely participates in the action(s) of a principal agent, or shares in the agents intention, either for its own sake or as a means to some other goalImmediate Material Cooperation. Immediate material cooperation occurs when the cooperator participates in circumstances that are essential to the commission of an act, such that the act could not occur without this participation.Mediate Material Cooperation. Mediate material cooperation occurs when the co-operator participates in circumstances that are not essential to the commission of an action, such that the action could occur even without this cooperation. Mediate material cooperation in an immoral act might be justifiable under three basic conditions:

If there is a proportionately serious reason for the cooperation (i.e., for the sake of protecting an important good or for avoiding a worse harm); the graver the evil the more serious a reason required for the cooperation; The importance of the reason for cooperation must be proportionate to the causal proximity of the co-operator's action to the action of the principal agent (the distinction between proximate and remote); The danger of scandal (i.e., leading others into doing evil, leading others into error, or spreading confusion) must be avoided

Principle of human dignityEvery human being should be acknowledged as an inherently valuable member of the human community and as a unique expression of life.Respect Human Rights

Principle of informed consentInformed consent in ethics usually refers to the idea that a person must be fully informed about and understand the potential benefits and risks of their choice of treatment. An uninformed person is at risk of mistakenly making a choice not reflective of his or her values or wishes. It does not specifically mean the process of obtaining consent, nor the specific legal requirements, which vary from place to place, for capacity to consentPatients can elect to make their own medical decisions, or can delegate decision-making authority to another party. If the patient is incapacitated, laws around the world designate different processes for obtaining informed consent, typically by having a person appointed by the patient or their next of kin make decisions for them. The value of informed consent is closely related to the values of autonomy and truth telling.A correlate to "informed consent" is the concept of informed refusal.

Principle of integrity and totalityThese principles dictate that the well-being of the whole person must be taken into account in deciding about any therapeutic intervention or use of technology . Therapeutic procedures that are likely to cause harm or undesirable side effects can be justified only by a proportionate benefit to the patient.Example (x- rays, scans)Principle of proportionate and disproportionate means Often used synonymously with the term "ordinary/extraordinary means

the principle holds that one is obligated to preserve his or her own life by making use of ordinary means, but is under no obligation to use extraordinary means . In other words, when a medical intervention or "means" is proportionate, one has a general obligation--all things considered--to accept the treatment. When the medical intervention constitutes a disproportionate means, then one is no longer obliged to undergo the treatment. Since judgments that a given Principle of religious freedomAll persons have a right to religious freedom, which has its foundation in human dignity. This principle implies that competent individuals should never be forced to act in a manner contrary to their religious beliefs and that they have the right to refuse participation in any treatment or procedure that is contrary to their conscience, nor should they be restrained from acting in accordance with their own beliefs, within due limits.When a competent patient refuses a medical or surgical procedure on the basis of religious convictions, then those treatments which otherwise might be considered proportionate means by others may legitimately be considered disproportionate means for religious reasons. In such cases, it may be appropriate to remind the patient of the risks involved in foregoing treatment. If such efforts fail, however, it would be considered a violation of this principle to coercively administer the procedure. It also would be generally inappropriate to seek a court order so as to force the patient to submit to the procedure. If the patient for whom the medically necessary treatment is being refused on the grounds of religious freedom is a child or infant and his or her life is at stake, guardianship might be sought on the grounds that the parents are failing in their moral and legal obligation to provide normal care for their child. Probate courts frequently override surrogate decisions made on behalf of minors to forgo life-sustaining treatment on the basis of religious convictions. Exceptions are made in the cases of "mature minors." In the case of a child or infant, it should also be noted that the physician and hospital run the risk of legal liability if they do not provide treatment and the child or infant dies as a consequencePrinciple of respect for autonomyAutonomy is given a central place or primary status in the prevailing modern liberalism of contemporary society, as reflected in Oregons Measure 16 that legalized physician-assisted suicide. However, the principle of respect for autonomy implies that autonomy has only a standing, that is, it can be overridden by competing moral considerations. For example, if an individuals choices endanger public health, potentially harm others, or require a scarce resource, that individuals autonomy may justifiably be restricted. Principle of respect for personsAll individual human beings are presumed to be free and responsible persons and should be treated as such in proportion to their ability in the circumstancesPrinciple of stewardshipStewardship requires us to appreciate the two great gifts that a wise and loving God has given: the earth, with all its natural resources, and our own human nature, with its biological, psychological, social and spiritual capacities. Principle of subsidiaritysubsidiarity requires those in positions of authority to recognize that individuals have a right to participate in decisions that directly affect them, in accord with their dignity and with their responsibility to the common good. Decisions should be made at the most appropriate level in a society or organization, that is, one should not withdraw those decisions or choices that rightly belong to individuals or smaller groups and assign them to a higher authority.

Principle of tolerationA greater good or set of goods would be lost if the evil action were not tolerated; or, if greater evils would occur were the original evil not tolerated. PROFESSIONALISM IN PHYSIOTHERAPYPROFESSIONAL BEHAVIORPT applicants are expected to act professionally in all of their dealings with PTCAS(physical therapy centralised application service) and the physical therapist programs.CORE VALUESThe APTA has identified seven core values that define the critical elements of professionalism in physical therapy. AccountabilityAltruismCompassion/CaringExcellenceIntegrityProfessional DutySocial ResponsibilityAccountability - Accountability is active acceptance of the responsibility for the diverse roles, obligations, and actions of the physical therapist including self-regulation and other behaviors that positively influencepatient/client outcomes, the profession and the health needs of society.Responding to patients/clients goals and needs.Seeking and responding to feedback from multiple sources.Acknowledging and accepting consequences of his/her actions.Assuming responsibility for learning and change.Adhering to code of ethics, standards of practice, and policies/procedures that govern the conduct of professional activities.Communicating accurately to others (payers, patients/clients, other health care providers) about professional actions.Participating in the achievement of health goals of patients/clients and society.Seeking continuous improvement in quality of care.Maintaining membership in APTA and other organizations.Educating students in a manner that facilitates the per suit of learning.

Altruism - Altruism is the primary regard for or devotion to the interest of patients/clients, thus assuming the fiduciary responsibility of placing the needs of the patient/client ahead of the physical therapists self interest. Placing patients/clients needs above the physical therapists. Providing pro-bono services. Providing physical therapy services to underserved and underrepresented populations. Providing patient/client services that go beyond expected standards of practice. Completing patient/client care and professional responsibility prior to personal needs.

Compassion/ Caring - Compassion is the desire to identify with or sense something of anothers experience; a precursor of caring. Caring is the concern, empathy, and consideration for the needs and values of others. Understanding the socio-cultural, psychological and economic influences on the individuals life in their environment. Understanding an individuals perspective. Being an advocate for patients/clients needs. Communicating effectively, both verbally and non-verbally, with others taking into consideration individual differences in learning styles, language, and cognitive abilities, etc. Designing patient/client programs/interventions that are congruent with patient/client needs. Empowering patients/clients to achieve the highest level of function possible and to exercise self-determination in their care. Focusing on achieving the greatest well-being and the highest potential for a patient/client. Recognizing and refraining from acting on ones social, cultural, gender, and sexual biases. Embracing the patients/clients emotional and psychological aspects of care. Attending to the patients/clients personal needs and comforts. Demonstrating respect for others and considers others as unique and of value.

Excellence - Excellence is physical therapy practice that consistently uses current knowledge and theory while understanding personal limits, integrates judgment and the patient/client perspective, embraces advancement, challenges mediocrity, and works toward development of new knowledge.Demonstrating investment in the profession of physical therapy. Internalizing the importance of using multiple sources of evidence to support professional practice and decisions. Participating in integrative and collaborative practice to promote high quality health and educational outcomes. Conveying intellectual humility in professional and interpersonal situations.

Using evidence consistently to support professional decisions. Demonstrating a tolerance for ambiguity. Pursuing new evidence to expand knowledge. Engaging in acquisition of new knowledge throughout ones professional career. Sharing ones knowledge with others. Contributing to the development and shaping of excellence in all professional roles.

Integrity - Steadfast adherence to high ethical principles or professional standards; truthfulness, fairness, doing what you say you will do, andspeaking forth about why you do what you do.

Abiding by the rules, regulations, and laws applicable to the profession.

Adhering to the highest standards of the profession (practice, ethics, reimbursement, Institutional Review Board [IRB], honor code, etc).

Articulating and internalizing stated ideals and professional values.

Using power (including avoidance of use of unearned privilege) judiciously.

Resolving dilemmas with respect to a consistent set of core values.

Being trustworthy. Taking responsibility to be an integral part in the continuing management of patients/clients. Knowing ones limitations and acting accordingly. Confronting harassment and bias among ourselves and others. Recognizing the limits of ones expertise and making referrals appropriately. Choosing employment situations that are congruent with practice values and professional ethical standards. Acting on the basis of professional values even when the results of the behavior may place oneself at risk.

Professional Duty - Professional duty is the commitment to meeting ones obligations to provide effective physical therapy services to individual patients/clients, to serve the profession, and to positively influence the health of society.Demonstrating beneficence by providing optimal care. Facilitating each individuals achievement of goals for function, health, and wellness. Preserving the safety, security and confidentiality of individuals in all professional contexts. Involved in professional activities beyond the practice setting. Promoting the profession of physical therapy. Mentoring others to realize their potential. Taking pride in ones profession.

Social Responsibility - Social responsibility is the promotion of a mutual trust between the profession and the larger public that necessitates responding to societal needs for health and wellness.Advocating for the health and wellness needs of society including access to health care and physical therapy services. Promoting cultural competence within the profession and the larger public. Promoting social policy that effect function, health, and wellness needs of patients/clients. Ensuring that existing social policy is in the best interest of the patient/client. Advocating for changes in laws, regulations, standards, and guidelines that affect physical therapist service provision.

Promoting community volunteerism. Participating in political activism. Participating in achievement of societal health goals. Understanding of current community wide, nationwide and worldwide issues and how they impact societys health and well-being and the delivery of physical therapy. Providing leadership in the community. Participating in collaborative relationships with other health practitioners and the public at large. Ensuring the blending of social justice and economic efficiency of services.