Ethics, Laws, and Regulations for California Physical Therapy

CONTACT HOURS: 2

Copyright © 2024 Wild Iris Medical Education, Inc. All Rights Reserved.

BY: 

Monica M. Roe, DPT, PT; Persis Mary Hamilton, EdD, MSN, BSN, PHN, PMHN

LEARNING OUTCOME AND OBJECTIVES:  Upon completion of this course, you will have gained the knowledge to incorporate ethical and legal principles and behaviors into the practice of physical therapy in California. Specific learning objectives to address potential learning gaps include:

  • Define “ethics.”
  • Summarize the fundamental ethical principles generally associated with the practice of healthcare.
  • Discuss the American Physical Therapy Association’s (APTA) “Code of Ethics for the Physical Therapist.”
  • Discuss APTA’s “Standards of Ethical Conduct for the Physical Therapist Assistant.”
  • Outline the basis and sources of law in the United States.
  • Discuss the elements of the California Physical Therapy Practice Act.
  • Identify how civil and criminal law apply to the practice of physical therapy.

TABLE OF CONTENTS

  • What Are Ethics?
  • Codes and Standards of Ethical Conduct
  • Legal Issues and Physical Therapy Practice
  • Conclusion
  • Resources
  • References

WHAT ARE ETHICS?


Ethics refers to a system or set of moral principles that govern behavior, including job performance. Ethics includes beliefs about the “rightness” and “wrongness” of actions as well as the “goodness” and “badness” of motives and outcomes (Merriam-Webster, 2024a). Physical therapists and physical therapist assistants must practice according to the ethical principles of their profession as described in the Code of Ethics for the Physical Therapist and the Standards of Ethical Conduct for the Physical Therapist Assistant (see below).

The terms laws and ethics are distinct from one another, although some individuals mistakenly assume they mean the same thing. In the United States, law refers to “a rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority” (Merriam-Webster, 2024b). Physical therapists and physical therapist assistants must practice according to the laws that govern their society as well as their physical therapy practice.

Why are ethics so important to consider, both in the practice of healthcare in general and physical therapy in particular? As physical therapists and physical therapist assistants assume a more autonomous role in healthcare, ethical judgments play an important role in the scope of sound clinical decision-making. In addition to potential legal consequences, unethical behavior risks loss of trust among the public, both for individual physical therapists and physical therapist assistants as well as for the profession as a whole (FSBPT, 2024).

Ethical Theories

Philosophers engaged with questions of ethics have generally sought to formulate and justify ethical theories. These theories are intended to explain the fundamental nature of that which is “good,” why it is “good,” and why the ethical principles most commonly used to evaluate human conduct follow (or do not follow) from these theories. Ethical theories may be presented for different purposes, as described by the examples below:

  • Descriptive (comparative) ethics seek to describe what people consider to be “good” or “right.” Such theories may be considered true or false depending on whether they do indeed describe correctly what people consider to be good or right. Example: asking a group of subjects whether they consider it right or wrong for a man to steal a drug to save his wife’s life, with the aim of describing the moral reasoning that lay behind their decisions (Johnstone, 2023).
  • Normative (prescriptive) ethics observe and describe what people consider to be right or wrong and then come to a conclusion about what is or is not right in that society. Such theories prescribe how people ought to act. Example: determining whether it is indeed right or wrong for a man to steal a drug to save his wife’s life according to society’s ethical standards.
  • Teleological ethical theory, also called consequentialist theory, claims that it is the consequence, or end result, of an action that determines whether the action is right or wrong. Example: withholding bad news from a patient because doing so will help the patient in the long run.
  • Deontological ethical theory argues that the motivation or intention for one’s action, as opposed to the consequences of the action, determines whether the action is right or wrong (Britannica, 2023). Example: not restraining a patient against their will even if it may help the patient in some way.

Ethical Principles

Four fundamental ethical principles are generally accepted and applied to the practice of healthcare as a whole:

  • Autonomy refers to the ability of an individual to think, decide, and act upon one’s own initiative. It is the responsibility of healthcare providers to provide sufficient and accurate information to a patient to allow the patient to make informed decisions and to honor a patient’s decisions regarding their own healthcare even when a patient’s decision may diverge from what the healthcare team would choose.
  • Beneficence means working actively for the best interests of the patient. This principle highlights the general concept of doing good for others and, in the context of a provider–patient relationship, entrusts a healthcare provider with performing professional and clinical duties in a competent, caring manner that will benefit the patient.
  • Nonmaleficence means to do no harm to a patient. This may mean carefully weighing potential benefits against potential negative results or side effects that may potentially result from providing healthcare interventions.
  • Justice refers to treating all patients fairly and equally in similar situations, regardless of a patient’s age, disability status, socioeconomic status, race, religion, gender identification, sexual orientation, or other background factors.

These four ethical principles are general standards of conduct by which actions can be measured (Varkey, 2021; Johnstone, 2023).

ETHICS VERSUS VALUES

While the terms ethics and values are often used interchangeably, they are actually quite different in meaning. Ethics constitutes a broadly accepted collection of moral principles; values are much more individualized and relate to an individual’s personal set of standards regarding what is right, important, and valuable (McNamara, 2023).

Ethical Dilemmas

An ethical dilemma is a conflict between choices that, no matter which choice is made, some ethical principle will be compromised. How to determine what is morally “right” is rarely straightforward.

A physical therapist who encounters an ethical dilemma at work is confronted by the following three basic questions:

  • What should I do?
  • What is the morally “right” thing to do?
  • How do I ensure that my actions are morally “right”?
    (Johnstone, 2023)

In order to resolve an ethical dilemma in the best possible way, several steps should be taken. These include:

  1. Consider the consequences of both choices, particularly the positive and negative results from each.
  2. Consider the actions of those choices. Do one’s actions line up with the moral principles regarding honesty, fairness, and respect for other people?
  3. Decide what to do and explain one’s reasoning to those who are affected by the decision.
    (Hegde, 2023)
CASE

Tyler works as a physical therapist on the postoperative orthopedic floor of a large urban hospital. When Tyler arrives at the room of Mr. Akhinga, who has had bilateral total knee replacements, to begin his scheduled morning physical therapy session, he finds the patient still in bed in his hospital gown. When Tyler inquires about this at the nurse’s station, he is told that Mr. Akhinga stated that he did not want any physical therapy today “because I’m in too much pain.” This is the third time this has happened this week.

Tyler now faces an ethical dilemma. While the ethical principle of autonomy dictates that Mr. Akhinga does indeed have the right to accept or refuse physical therapy interventions, Tyler is concerned that continued missed therapy sessions may lead to a poorer overall functional outcome for Mr. Akhinga in the long term. This would run counter to the ethical principle of beneficence, or acting in a clinical manner that would positively affect a patient’s well-being.

Tyler documents the missed visit for the morning and goes immediately to his rehab director to discuss the dilemma. Tyler and the rehab director consult with the nursing staff, a social worker, and Mr. Akhinga’s surgeon, as well as with Mr. Akhinga and his wife. It is eventually discovered that Mr. Akhinga’s postoperative pain has not been sufficiently managed by his currently prescribed medication, but he has been hesitant to discuss his discomfort with his nurses because, in his words, “I didn’t want to bother them, they’re already so busy.”

It is decided that Mr. Akhinga’s surgeon will adjust his medication to better manage his pain and that his nursing personnel will verbally ask Mr. Akhinga to rate his pain at regular intervals throughout the day. The rehab director offers to make Mr. Akhinga’s physical therapy schedule available to the nursing staff on the postop floor several days in advance so that his medication schedule and therapy schedule may be coordinated.

The consultations and agreed-upon course of action are documented in Mr. Ankinga’s medical record, and Mr. Akinga seems pleased with the plan of action. Within one day, he is reporting significantly less pain and is once again willing to participate in physical therapy.