ETHICS AND PROFESSIONALISM

1. ETHICS AND PROFESSIONALISM

2. Physiotherapy • Define? • Treated age groups? • Specialities? • Non-patient care roles? • Education level?

3. History of physiotherapy • In 460 BC – Hippocrates and Hector ,later Galenus • First practioners of physical therapy. • Used massage and hydrotherapy. • 18th century – orthopaedic developed • Gymnasticons and ex’s developed to treat gout • 1813 , Per Henrik Ling,(father of Swedish gymnastics) • Found Royal central institute of gymnastics (RCIG),for massage ,ex’s and manipulation • Sjukgymnast –someone involved in gymnastic, for those who are ill.

4. 1887 –PT’s 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 Zealand • 1914 – Reed college in Portland • These are the examples of institution that taught PT, they graduated “Reconstruction Aides”

5. End 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 ex’s) • Promoted during polio outbreak in 1916 • 1917-1918 (1st world war) –therapy performed widely and called as Rehabilitation therapy • People were named as Reconstruction Aide.

6. 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)formed • AWPTA........later called as APTA(American Physical Therapy Association) • Mother of Physical therapy due to her contribution.

7. 1924 – the Georgia Warm Spring foundation promoted physical therapy in the treatment of polio. • 1940’s – main physio practice was massage, traction and ex’s. • 1950’s – manipulation for spine practised • Moved beyond hospitals • 1974 – ortho speciality in physio was formed in APTA • International Federation of Orthopaedic Manipulative therapy was established, Manual therapy popularised

8. 1980’s – further development in physio was recorded • Therapies involved are: • US therapy / Exercise therapy • SWD / Wax therapy • IFT / Cryotherapy • TENS • Stimulations • Laser • IRR

9. ETHICS • The 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.

10. MEDICAL ETHICS • Medical 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.

11. 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 harm” • Justice - 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. • Truthfulness and honesty -

12. Code of ethics for PT • Principle #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.

13. 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.

14. 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.

15. 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 patient’s/client’s 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.

16. 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 personnel

17. Principle #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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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 judgment

24. 7D. 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.

25. 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.

26. 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.

27. Key Ethical Principles • Principle of beneficence • Principle of the common good • Principle of distributive justice • Principle of double effect • Principle of formal and material co-operation • Principle of human dignity • Principle of informed consent • Principle of integrity and totality • Principle of proportionate and disproportionate means

28. Principle of religious freedom • Principle of respect for autonomy • Principle of respect for persons • Principle of stewardship • Principle of subsidiarity • Principle of toleration

29. Principle of beneficence • Traditionally 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.

30. 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)

31. nonmaleficence not simply as "doing no harm," but as "doing no evil," which is closer to its etymological roots

32. Principle of the common goods • In 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 flourishing

33. the 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 rights • 2) 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)

34. Principle of distributive justice • Distributive 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.

35. Principle of double effect • Double 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.

36. Examples of double effect ; • Administering vaccine (medical) • Pregnancy and abortion • In war(bomb)

37. Principle of formal and material co-operation • Moralists 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-operation • Immediate material co-operation • Mediate material co-operation

38. Formal Cooperation. Formal cooperation occurs when a person or organization freely participates in the action(s) of a principal agent, or shares in the agent’s intention, either for its own sake or as a means to some other goal • Immediate 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.

39. 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

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

41. Principle of informed consent • Informed 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 consent

42. Patients 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.

43. Principle of integrity and totality • These 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)

44. 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

45. Principle of religious freedom • All 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.

46. 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.

47. 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 consequence

48. Principle of respect for autonomy • Autonomy is given a central place or primary status in the prevailing modern liberalism of contemporary society, as reflected in Oregon’s 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 individual’s choices endanger public health, potentially harm others, or require a scarce resource, that individual’s autonomy may justifiably be restricted.

49. Principle of respect for persons • All individual human beings are presumed to be free and responsible persons and should be treated as such in proportion to their ability in the circumstances

50. Principle of stewardship • Stewardship 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.