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Ethics is derived from the Greek

word ethicos which means


arising from custom.
When most people think of ethics
(or morals), they think of rules
for distinguishing between right
and wrong.
(by David B. Resnik, J.D., Ph.D.)
Ethics are norms for conduct that
distinguish
between
the
acceptable
and
unacceptable

Ethical norms are so ubiquitous


that one might be tempted to
regard
them
as
simple
commonsense.
Ethics' focuses on the disciplines
that study standards of conduct.
Definition- Ethics is a method,
procedure,
or
perspective
for
deciding how to act and for
analyzing complex problems and
issues

Steadman s medical dictionary defines

medical ethics as the science of morality.


Ethics is not definable, is not
implementable, because it is not
conscious; it involves not only our
thinking, but also out feeling.
- Valdemar W. Setzer

THE TIME IS ALWAYS RIGHT TO DO WHAT IS


RIGHT
Dr. Martin Luther King Jr.

HISTORICAL ASPECT
RELIGIOUS INFLUENCE

5th B.C :
Hippocratic oath
developed
from a religious sect
known
as Pythagoreans.
Small groups of
physician who
live in Isle of Cos.

Middle age :
Monks dominated medical
practice.
Catholics have integrated
principles
of medical decision making in
their
theology.

1789 : (Epidemic of typhoid)


Chaos erupted in an English
hospital when the staff were
required to assume, additional,
unfamiliar task .
Even some of the staff members
resigned.
A retired Physician named
Thomas Percival sought to
restore calm.
He design a code of professional
conduct later published as
Medical Ethics

1847 : American medical


association, include Percival every
words.
tenderness with steadiness and
condescension with autonomy
were expected to
inspire the mind of their patient
with gratitude ,respect and
confidence

Nuremberg trials (1949) .


Medical experiments conducted by
the Nazis on concentration camp
prisoners
resulted in the Nuremberg Code .
- subject participation must be
voluntary.
experiments must be supported
by
strong scientific material.

- physical or mental suffering


or damage is not acceptable.
subject has the right to
withdraw
from.
1959 - Code of Medical
Ethics, MCI

ETHICAL
ANALYSIS

Whenever PT faces a moral


problems that does not lend itself
to resolution by reference to
existing guidelines,
4 areas of consideration should be
taken,

1.What are the relevant facts


of the case?
Does the patient know
exactly what happened.
Information.
2.Given the facts, what
makes this a moral problem

3.Finally one settles on a course of


action.
4.To identify the types of conflict and
set priorities among the moral norms.
5.Utilisation approach is most
defensible course the most good for
most people.
6.Formalist or deontologist approach
identify certain moral norms that will
always hold more weight and to be
governed by them to identify a
course of action.

ETHICAL ISSUES IN
PHYSICAL THERAPY

Ethics in physiotherapy can be defined


as the moral code of conduct that
defines the relationship between the
1. Therapist and her patient or client,
and
2. The therapist and other healthcare
professionals based on mutual respect
and trust.

In 1935, a group of
physiotherapists convened in
Atlantic City and drafted a Code

a.Diagnosing, stating the prognosis

of a case and prescribing treatment


shall be entirely the responsibility of
the physician.
Any assumption of this
responsibility by one of our
members shall be considered
unethical.

b. The patient shall be referred

back to the physician for


periodical examinations.
As physical therapists assume a
more autonomous role in health
care delivery, ethical judgments will
play an increasingly important role
in the gamut of clinical decisions a
physical therapist will have to
make.
(Charles Magistro -1989)

(Thomas

Beauchamp
Four principles

1.AUTONOMY:
Autonomy of the
client/ patient to
opt for or out of
any treatment options is available to
him.
If the health provider is able to respect
the clients right to autonomy, much of
the ethical burden will be taken care of.
Right to information , respect for
individual

2.BENEFICENCE :
This is the duty of the health
provider to ensure that the client
in her care is assured of all the
benefits of her professional
knowledge to help the person
overcome their dysfunction.

3. JUSTICE :
The duty of the
health provider
to ensure that
justice is done to
the individuals in her care.
This involves equal and unbiased
care, respect for autonomy, and
the duty to provide the correct
information to the best of her
knowledge if called upon by a court
of law.

Decision about how to


distribute scarce resource
according to some acceptable
standard of fairness and
equity.
Political and government issue
4. NON-MALEFICENCE :
Ensure that no harm is done to
the best of her knowledge.

INFORMED CONSENT
Authorization by the patient or patient
legal representative to do something
to the
patient.
Explanation of the treatment
procedure to
be performed and expected result of
treatment .
Description of risk.
Name of PT.
Person giving consent must have the
opportunity to have all questions
answered.

CONFIDENTIALY
PT has duty to keep it a
secret the harmful or
embarrassing information
revealed by the patient.

Commitment to honoring
confidences can be momentous
challenge.

INTER PROFESSIONAL ISSUE


Many PT are worried
that the practice of
working in a physician
management or other
privately owned
physical therapy clinics
entails built in
conflicts of interest.

Physician -Therapist relationship.


PT can examine ways and
arrangement can be design to
preserve the inter- professional
integrity while better meeting
the
needs of patient.

ECONOMIC :
Therapist weigh her
treatment
option judiciously.

QUESTIONS

ETHICAL ISSUES IN
RESEARCH
Research ethics involves the

application
of fundamental ethical principles to a
variety of topics involving scientific
research.
These include the design and
implementation of research involving
human experimentation, animal
experimentation, various aspects of
academics.

BELMONT report :
1974
Respect for person ,
justice,
Beneficence.
ICMR a regulatory body for
research in India.

Why
ethics important in
1.
research?

1. Promote the aims of research, such as


knowledge, truth, and avoidance of
error.

2. Promote the values that are


essential to
collaborative
work, such as trust,
accountability, mutual respect, and
fairness.

3. Help to ensure that


researchers
can be held accountable
to the
public.
4. Build public support for
research.
5. Moral and social values.

CONFIDENTIALITY
Protect confidential
communications, such as papers
or
grants submitted for publication.
Personnel records.
Trade or military secrets.
Patient records.

PROCESS OF INFORM
CONSENT
Procedure.
Risk and benefits.
Alternatives.
Withdrawel.

HUMAN SUBJECT
PROTECTION
When conducting research on
human subjects, minimize harms
and risks and maximize benefits.
Respect human dignity, privacy,
and autonomy;
Take special precautions with
vulnerable populations; and
Strive to distribute the benefits
and burdens of research fairly.

HONESTY

Strive for honesty in all scientific


communications.
Honestly report data, results, methods
and procedures, and publication
status.
Do not fabricate, falsify, or
misrepresent
data.
Do not deceive colleagues, granting
agencies, or the public.

INTEGRITY
Keep your promises and agreements
Act with sincerity.
Strive for consistency of thought
and
action.

OBJECTIVITY
Strive to avoid bias in

experimental design, data


analysis, data interpretation, peer
review, personnel decisions, grant
writing, expert testimony, and
other aspects of research
Disclose personal or financial

interests that may affect research.

CAREFULLNESS
Avoid careless errors and negligence.
Carefully and critically examine your
own work and the work of your peers.
Keep good records of research
activities,
such as data collection, research
design,
and correspondence with agencies or
journals.

OPENNESS
Share data, results, ideas,
tools,
resources.
Be open to criticism and new
ideas.

RESPECT FOR
INTERLECTUAL PROPERTY
Honour patents, copyrights, and other

forms of intellectual property.


Do not use unpublished data,
methods, or results without
permission.
Give proper acknowledgement or

credit for all contributions to research.


Never plagiarize

RESPONSIBLE
PUBLICATION

Publish in order to advance


research and
scholarship, not to advance just
your
own career.
Avoid wasteful and duplicative
publication.

RESPONSIBLE
MENTORING
Help to educate, mentor, and

advise students.
Promote their welfare and

allow them to make their own


decisions.

RESPECT COLLEAGUES
Respect your colleagues

and
Treat them equally.

SOCIAL
RESPONSIBILITY
To promote social good .
Prevent or mitigate social

harms through research.


Public education, and
Advocacy.

NON DISCRIMINATION
Avoid discrimination against

colleagues or students on the


basis of sex, race, ethnicity,
or other factors that are not
related to their scientific
competence and integrity.

COMPETENCE
Maintain and improve
your own professional
competence and
expertise through
lifelong education and
learning.

LEGALITY
Know and obey relevant

laws .
Institutional .
Governmental policies

ANIMAL CARE

When people who are morally weak,

ignorant, or insensitive are placed in


stressful or imperfect environments.

Examples:
Publishing the same paper in two different
journals without telling the editors
Not informing a collaborator of your intent
to file a patent in order to make sure that
you are the sole inventor
Including a colleague as an author on a
paper in return for a favour even though the
colleague did not make a serious
contribution to the paper
Bypassing the peer review process and
announcing your results through a press
conference without giving peers adequate
information to review your work

QUESTIONS

ETHICAL ISSUES IN
ACADEMICS

Ethics must begin at the top


of an organization.
It is a leadership issue and
the chief executive must set
the example.
- Hennessey

The clinical education site and the

provider of physical therapy


should have a written statement of
philosophy.

CLINICAL EDUCATION

EXPERIENCES FOR STUDENTS


ARE PLANNED TO MEET
SPECIFIC OBJECTIVES OF THE
ACADEMIC PROGRAM.

Does not discriminate on the


basis of
race, creed, color, gender, age,
national or ethnic origin, sexual
orientation or disability or health
status.

Evaluation of student .Examiner.

PHYSICAL THERAPY
PERSONNEL PROVIDE
SERVICES IN AN ETHICAL
AND LEGAL MANNER
The clinical education site

has evidence of valid


licensure, registration, or
certification for all physical
therapists and physical
therapist assistants.

Policy and Procedure Manual,

which includes a copy of the


state practice act and
interpretive rules and
regulations.
The clinical education site as
written statements regarding
nondiscrimination in its hiring,
promotion and retention
practices

The clinical education site ensures


that each
student is provided equal
opportunities,
learning experiences, and Benefits.

The clinical education site is

sensitive to issues of
individual and cultural
diversity in clinical education.
The clinical education site
facilitates growth of clinical
educators by providing
educational opportunities
related to clinical education .

Students in clinical

education are primarily


concerned with delivery of
services to patients/clients;
therefore, the provider of
physical therapy must have
an adequate number and
variety of patients/clients.

The clinical education site

provides a clinical experience


appropriate to the students level
of education and prior
experiences.
Expose students to various
management practices, such as
resource utilization, quality
improvement, reimbursement,
cost containment, scheduling, and
Productivity.

Expose students to teaching

experiences, if available and


appropriate, such as in-service
programs and patient/client, family,
caregiver and consumer education.
Expose students to various
scholarly activities, if available and
appropriate, such as journal club,
continuing education/in-services,
literature review, case study and
clinical research.

Possible use of

information technology
includes e-mail, voice
mail, computer
documentation, and
electronic pagers.

Support services

Health care, emergency medical

care, and pharmaceutical


supplies;
library facilities, educational
media and equipment,
duplicating services, and
computer services room and
board, laundry, parking, special
transportation, and recreational
facilities.

PHYSICAL THERAPIST:
Job descriptions.
always praise in public and

reprimand in private.
Organizational chart clearly
identifies the lines of
communication to be used by
the student .
Organizational charts should
also reflect all personnel
relationships.

Student-personnel ratio can vary

according to the provision of the


physical therapy services, the
composition and expertise of the
personnel.
Physical therapist
responsibilities for patient/client
care, teaching, critical inquiry
and community service permit
adequate time for supervision of
physical therapy Students

Special expertise may be offered


by select physical therapy
personnel.
The physical therapy personnel
should be encouraged to be
active at local, state, or national
levels.
Self-improvement activities,
career enhancement activities,
membership in professional
associations .

Evaluation of the provider of

physical therapy should occur at


regularly scheduled intervals.

Evaluation methods may

include, but are not limited to,


continuous quality improvement,
peer review, utilization review,
medical audit, program
evaluation, and consumer
satisfaction monitors.

Ragging

To educate a person in mind


and not in morals is to
educate a menace to society.
Theodore Roosevelt

REVISED at the General Meeting


22-24 May 2008 Athens, Greece.

1: Physical therapists
respect the rights and
dignity of all individuals.

All persons who seek the services

of physical therapists have the right


to service regardless of age,
gender, race, nationality, religion,
ethnic origin, creed, colour, sexual
orientation, disability, health status
or politics.
Patients/clients have the right to:
services of good quality

Information

Informed consent
confidentiality
access to data
health education

Physical therapists shall apply


sound business principles when
dealing with suppliers,
manufacturers and other
agents.
Physical therapists have the
absolute responsibility to
ensure that their behaviour is
at all times professional,
ensuring that the potential for
misconduct can not arise.

Principle 2: Physical therapists


comply with the laws and
regulations governing the practice
of physical therapy in the country
in which they work.
Physical therapists will have a full

understanding of the laws and regulations


governing the practice of physical
therapy.
Physical therapists have the right to
refuse to treat or otherwise intervene
when in their opinion the service is not in
the best interests of the patient/client.

Principle 3: Physical therapists


accept responsibility for the
exercise
sound are
judgment.
Physical of
therapists
professionally independent and
autonomous practitioners.
Physical therapists make
independent judgments in the
provision of services for which they
have knowledge and skills and for
which they can be held accountable.

For each individual accepted for

service, physical therapists


undertake appropriate
examination/evaluation to allow
the development of a diagnosis.
When the goals have been
achieved or further benefits can
no longer be obtained, the
physical therapist shall inform
and discharge the patient/client.

When the diagnosis is not

clear or the required


intervention is beyond the
capacity of the physical
therapist, the PT shall inform
the patient and provide
assistance to facilitate a
referral to other qualified
persons.

therapists provide an
honest, competent and
accountable professional
service
Physical therapists ensure

patients/clients understand
the nature of the service
being provided, especially the
anticipated costs, both time
and financial.

Physical therapists maintain

adequate patient/client records


to allow for the effective
evaluation of the
patients/client's care, as well as
the evaluation of the physical
therapist's practice.
Physical therapists shall not
allow their services to be
misused

Principle 5: Physical therapists


are committed to providing
quality services.
Aware of the currently accepted

standards of practice .
Physical therapists shall
participate in ongoing education
to enhance their basic knowledge
and to provide new knowledge.
Physical therapists shall support

research that contributes to improved


patient/client services .

Physical therapists shall


support quality education in
academic and clinical
settings.
Physical therapists engaged
in research shall abide by the
current rules and policies.

Physical therapists in the


role of employer shall:
Ensure all employees are

properly and duly qualified,


ensuring compliance with
statutory requirements
Ensure implementation and
monitoring of appropriate
policies and procedures

Ensures appropriate evaluation

and audit of clinical practice.


Provide adequate

opportunities for staff


education and personal
development based on
effective performance appraisal

therapists are entitled to a


just and fair level of
remuneration for their
services.
Physical therapists should ensure that

their own fee schedules are based on


reasonable considerations.
Physical therapists should attempt to
ensure that third-party fee schedules
are based on reasonable considerations.
Physical therapists shall not use undue
influence for personal gain.

Principle 7: Physical therapists


provide accurate information
to patients/clients, other
agencies and the community
about physical therapy and
about the services physical

Physical therapists
therapists
provide.shall
participate in public education
programmers, providing
information about the
profession.

Physical therapists may

advertise their services;


Physical therapists shall not use
false, fraudulent, misleading,
deceptive, unfair or sensational
statements or claims.
Physical therapists shall claim
only those titles which correctly
describe their professional
status.

Principle 8: Physical
therapists contribute to the
planning and development
of services which address
the health needs of the

Physical therapists have a duty


community.
and an obligation to participate
in planning services designed
to provide optimum community
health services.

Physical therapists are obliged to


work toward achieving justice in
the provision of health services
for all people.

APTA
GUIDELINES FOR
PROFESSIONAL
CONDUCT :
The interpretations expressed in this
Guide reflect the opinions, decisions, and
advice of the Ethics and Judicial
Committee.

PRINCIPLE1.A physical
therapist shall respect the
rights and dignity of all
individuals and shall provide
compassionate care.
Attitudes of a Physical Therapist
A. A physical therapist shall
recognize, respect, and respond to
individual and cultural differences
with compassion and sensitivity.

B. A physical therapist shall be

guided at all times by


concern for the physical,
psychological, and
socioeconomic welfare of
patients/clients
C. A physical therapist shall not
harass, abuse, or
discriminate against others.

PRINCIPLE 2
A physical therapist shall act
in a trustworthy manner
towards patients/clients, and in
all other aspects of physical
Patient/Physical Therapist
therapy
practice .
Relationship .
Truthfulness
Confidential Information .
Patient Autonomy and Consent

PRINCIPLE 3: A physical
therapist shall comply with
laws and regulations
governing physical therapy
and shall strive to effect
changes
that
benefit
Professional Practice .
patients/clients.
Just Laws and Regulations .
Unjust Laws and

Regulations .

PRINCIPLE 4 A physical
therapist shall exercise
sound professional
judgment :
Professional Responsibility .
Direction and Supervision .
Practice Arrangements .
Gifts and Other Consideration.

PRINCIPLE 5 :A physical
therapist shall achieve and
maintain professional
competence.
Scope of Competence .
Self-assessment.
Professional Development .

PRINCIPLE 6 :A physical
therapist shall maintain
and promote high
standards for physical
therapy
practice,
Professional
Standards .
education
Practice . and research.
Professional Education .
Continuing Education .
Research

PRINCIPLE 7 : A physical
therapist shall seek only such
remuneration as is deserved
and reasonable for physical
therapy services.
Business and Employment

Practices .
Endorsement of Products or
Services .
Disclosure .

Accurate and
Information
PRINCIPLE
8 : Relevant
A physical
therapist
to
the
Patient.
shall provide and make available

Accurateand
and relevant
Relevant Information
accurate
to
the
Public
.
information to patients/clients
about their care and to the public
about physical therapy services.

PRINCIPLE 9 : A physical
therapist shall protect the
public and the profession from
unethical, incompetent, and
illegal acts.
Consumer Protection .

PRINCIPLE 10 : A physical
therapist shall endeavor to
address the health needs of
society.
Pro Bono Service .
Individual and Community
Health

PRINCIPLE 11 :A physical
therapist shall respect the
rights, knowledge, and skills of
colleagues and other
healthcare professionals.
Consultation .

Patient/Provider Relationships .
Disparagement .

ETHICAL
GUIDELINES FOR
IAP

Physiotherapist shall provide

honest quality care,


competent and accountable
professional consultancy,
therapeutic and otherwise, as
first contact practitioner to
any person who may seek or
may be in need of the same.

Physiotherapist shall

administer only such


treatment that is the
interest of the patient with
the responsibility for the
exercise of sound
judgement with diligence.

Physiotherapist shall
refer the patient to
appropriate specialist
whenever
problem/symptoms of
the diseases of the
patient demand.

Physiotherapist shall

maintain secrecy of the


patients diseases and shall
not divulge the same to any
other individual except to
professional colleagues
during scientific case
discussions or meeting.

Physiotherapist shall

provided accurate
information to the patient or
to the next relative if
required about the problem
and specific physiotherapy
management of that
individuals problem if
required.

The physiotherapy

management shall have the


prior consent of patient/relative
if the procedure adopted
involves risk of any damage to
the tissue, organ system or any
side effects/complications after
explaining the same accurately

Physiotherapist shall

comply with the laws


governing the patients
rights and cause.
Physiotherapist shall not

solicit patients through fee


splitting.

Physiotherapist shall constantly

strive to keep himself/herself


abreast of recent and latest
scientific developments related to
physiotherapy and add to
knowledge fund.
Physiotherapist shall not indulge
in or associate with any activity
that goes against the dignity
,honour and development of
profession.

Follow ethical practice

outlined in code of ethics.


Balance the wants, needs and

requirements of program
patients, institutional policies,
laws and sponsors.

Physiotherapist shall

contribute to the planning


and development of
professional service which
address the health needs of
the community.
Maintain high standards of

professional conduct.

Resist pressures to use their

influence inappropriately and


refuse to allow self
aggrandizement or personal
gain to influence their
professional judgments.
Seek appropriate guidance
and direction when faced with
ethical dilemas.

Make every effort to

ensure that their service


are offered to individual
and organizations with a
legitimate claim on these
services

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