CODES AND STANDARDS OF ETHICAL CONDUCT

Codes of ethics are formal statements that set forth standards of ethical behavior for members of a group. In fact, one of the hallmarks of a profession is that its members subscribe to a code of ethics. Every member of a profession is expected to read, understand, and abide by the ethical standards of its occupation.

The American Physical Therapy Association (APTA) is the definitive source for standards of ethics in the physical therapy profession. In order to assert the values and standards expected of members of the profession of physical therapy, the APTA publishes the Code of Ethics for the Physical Therapist, Standards of Ethical Conduct for the Physical Therapist Assistant, Core Values for the Physical Therapist and Physical Therapist Assistant, and Standards of Practice for Physical Therapy. These four documents are regularly revised and updated, with the latest codes and standards effective 2020 (APTA, 2024).

Portions of these documents are discussed below. (See also “Resources” at the end of this course.)

Code of Ethics for the Physical Therapist

[Material in this section is adapted from the Code of Ethics for the Physical Therapist, apta.org, with permission of the American Physical Therapy Association. © 2020, American Physical Therapy Association. All rights reserved.]

PREAMBLE

The Code of Ethics for the Physical Therapist delineates the ethical obligations of all physical therapists as determined by the House of Delegates of the American Physical Therapy Association. The purposes of the Code of Ethics are to:

  1. Define the ethical principles that form the foundation of physical therapist practice in patient and client management, consultation, education, research, and administration
  2. Provide standards of behavior and performance that form the basis of professional accountability to the public
  3. Provide guidance for physical therapists facing ethical challenges, regardless of their professional roles and responsibilities
  4. Educate physical therapists, students, other healthcare professionals, regulators, and the public regarding the core values, ethical principles, and standards that guide the professional conduct of the physical therapist
  5. Establish the standards by which the American Physical Therapy Association can determine if a physical therapist has engaged in unethical conduct

Fundamental to the Code of Ethics is the special obligation of physical therapists to empower, educate, and enable those with impairments, activity limitations, participation restrictions, and disabilities to facilitate greater independence, health, wellness, and enhanced quality of life.

The Code of Ethics is applicable to all physical therapists and may change in response to evolving patterns of health care delivery and changing dynamics of the profession as a whole. No code of ethics is exhaustive nor can it address every situation. Physical therapists are encouraged to seek additional advice or consultation in instances where the guidance of the Code of Ethics may not be definitive.

ROLES, CORE VALUES, AND REALMS OF ETHICAL ACTION

The APTA’s Code of Ethics for the Physical Therapist delineates five roles, eight core values, and three realms of ethical action to which physical therapists are expected to adhere.

Roles assumed by physical therapists in professional practice include:

  1. Management of patients and clients
  2. Consultation
  3. Education
  4. Research
  5. Administration

Core values which physical therapists are expected to exemplify include:

  1. Accountability
  2. Altruism
  3. Collaboration
  4. Compassion/caring
  5. Duty
  6. Excellence
  7. Integrity
  8. Social responsibility

Realms of ethical action for physical therapists include:

  1. Individual
  2. Organizational
  3. Societal

PRINCIPLES

Throughout the Code, the primary core values that support specific principles are indicated in parentheses. Unless a specific role is indicated in the principle, the duties and obligations being delineated pertain to the five roles of the physical therapist.

  1. Physical therapists shall respect the inherent dignity and rights of all individuals. (Core Values: Compassion and Caring, Integrity)
    1. 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.
    2. Physical therapists shall recognize their personal biases and shall not discriminate against others in physical therapist practice, consultation, education, research, and administration.
  2. Physical therapists shall be trustworthy and compassionate in addressing the rights and need of patients and clients. (Core Values: Altruism, Collaboration, Compassion and Caring, Duty)
    1. Physical therapists shall adhere to the core values of the profession and shall act in the best interests of patients and clients over the interests of the physical therapist.
    2. Physical therapists shall provide physical therapist services with compassionate and caring behaviors that incorporate the individual and cultural differences of patients and clients.
    3. Physical therapists shall provide the information necessary to allow patients or their surrogates to make informed decisions about physical therapist care or participation in clinical research.
    4. Physical therapists shall collaborate with patients and clients to empower them in decisions about their healthcare.
    5. Physical therapists shall protect confidential patient and client information and may disclose confidential information to appropriate authorities only when allowed or as required by law.
  3. Physical therapists shall be accountable for making sound professional judgments. (Core Values: Collaboration, Duty, Excellence, Integrity)
    1. Physical therapists shall demonstrate independent and objective professional judgment in the patient’s or client’s best interest in all practice settings.
    2. Physical therapists shall demonstrate professional judgment informed by professional standards, evidence (including current literature and established best practice), practitioner experience, and patient and client values.
    3. 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 healthcare professionals when necessary.
    4. Physical therapists shall not engage in conflicts of interest that interfere with professional judgment.
    5. Physical therapists shall provide appropriate direction of and communication with physical therapist assistants and support personnel.
  4. Physical therapists shall demonstrate integrity in their relationships with patients and clients, families, colleagues, students, research participants, other healthcare providers, employers, payers, and the public. (Core Value: Integrity)
    1. Physical therapists shall provide truthful, accurate, and relevant information and shall not make misleading representations.
    2. Physical therapists shall not exploit persons over whom they have supervisory, evaluative, or other authority (e.g., patients/clients, students, supervisees, research participants, or employees).
    3. Physical therapists shall not engage in any sexual relationship with any of their patients and clients, supervisees, or students.
    4. Physical therapists shall not harass anyone verbally, physically, emotionally, or sexually.
    5. Physical therapists shall discourage misconduct by physical therapists, physical therapist assistants, and other healthcare professionals and, when appropriate, report illegal or unethical acts, including verbal, physical, emotional, or sexual harassment, to an appropriate authority with jurisdiction over the conduct.
    6. Physical therapists shall report suspected cases of abuse involving children or vulnerable adults to the appropriate authority, subject to law.
  5. Physical therapists shall fulfill their legal and professional obligations. (Core Values: Accountability, Duty, Social Responsibility)
    1. Physical therapists shall comply with applicable local, state, and federal laws and regulations.
    2. Physical therapists shall have primary responsibility for supervision of physical therapist assistants and support personnel.
    3. Physical therapists involved in research shall abide by accepted standards governing protection of research participants.
    4. Physical therapists shall encourage colleagues with physical, psychological, or substance-related impairments that may adversely impact their professional responsibilities to seek assistance or counsel.
    5. Physical therapists who have knowledge a colleague is unable to perform their professional responsibilities with reasonable skill and safety shall report this information to the appropriate authority.
    6. 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 or client continues to need physical therapist services.
  6. Physical therapists shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and professional behaviors. (Core Value: Excellence)
    1. Physical therapists shall achieve and maintain professional competence.
    2. Physical therapists shall take responsibility for their professional development based on critical self-assessment and reflection on changes in physical therapist practice, education, healthcare delivery, and technology.
    3. Physical therapists shall evaluate the strength of evidence and applicability of content presented during the professional development activities before integrating the content or techniques into practice.
    4. Physical therapists shall cultivate practice environments that support professional development, lifelong learning, and excellence.
  7. Physical therapists shall promote organizational behaviors and business practices that benefit patients and clients and society. (Core Values: Integrity, Accountability)
    1. Physical therapists shall promote practice environments that support autonomous and accountable professional judgments.
    2. Physical therapists shall seek remuneration as is deserved and reasonable for physical therapist services.
    3. Physical therapists shall not accept gifts or other considerations that influence or give an appearance of influencing their professional judgment.
    4. Physical therapists shall fully disclose any financial interest they have in products or services that they recommend to patients and clients.
    5. Physical therapists shall be aware of charges and shall ensure that documentation and coding for physical therapist services accurately reflect the nature and extent of the services provided.
    6. Physical therapists shall refrain from employment arrangements or other arrangements that prevent physical therapists from fulfilling professional obligations to patients and clients.
  8. Physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally. (Core Value: Social Responsibility)
    1. Physical therapists shall provide pro bono physical therapist services or support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured.
    2. Physical therapists shall advocate to reduce health disparities and healthcare inequities, improve access to healthcare services, and address the health, wellness, and preventive healthcare needs of people.
    3. Physical therapists shall be responsible stewards of healthcare resources and shall avoid overutilization or underutilization of physical therapist services.
    4. Physical therapists shall educate members of the public about the benefits of physical therapy and the unique role of the physical therapist.
CASE

Ibi is completing her final clinical rotation for her DPT program. Her rotation site is located at a small, critical-access hospital in rural Alaska. Ibi is excited about the wide variety of patients and conditions that she has had the opportunity to encounter in this generalist setting. In the second week of her rotation, Ibi’s clinical instructor (CI) informs her that three patients were admitted to the hospital the previous night with frostbite, and it is expected that they will all require wound care, possibly including skilled debridement, over the next several days.

Having grown up and attended school in Florida, Ibi has never encountered frostbite in a clinical setting. While Ibi has learned about wound care in her didactic program and performed various types of wound care under direct supervision from CIs during earlier student rotations, she has never performed skilled debridement independently. Ibi does not want to disappoint her CI and wants to receive a positive evaluation for this clinical, yet she does not feel confident in her ability to treat these patients on her own. What should Ibi do?

Discussion

Principle 6B of the Code of Ethics for the Physical Therapist clearly states that physical therapists should “take responsibility for their professional development based on critical self-assessment and reflection on changes in physical therapist practice, education, healthcare delivery, and technology.” Likewise, Principle 3C states that 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 healthcare professionals when necessary.”

Even though she wants to please her CI, Ibi should not perform procedures that are outside the scope of her experience, especially if she is not confident in her ability to perform them safely. Ibi should discuss her concerns with her supervisor at once, explaining that all of her prior rotations were in warm-weather locations and that she has never had the occasion to treat frostbite or to practice skilled debridement. Ibi should respectfully request that her CI provide her with guidance and appropriate training in these areas.

Standards of Ethical Conduct for the Physical Therapist Assistant

[Material in this section is adapted from the Standards of Ethical Conduct for the Physical Therapist Assistant, apta.org, with permission of the American Physical Therapy Association. © 2020, American Physical Therapy Association. All rights reserved.]

PREAMBLE

The Standards of Ethical Conduct for the Physical Therapist Assistant delineate the ethical obligations of all physical therapist assistants as determined by the House of Delegates of the APTA. The Standards of Ethical Conduct provide a foundation for conduct to which all physical therapist assistants shall adhere. Physical therapist assistants are guided by a set of core values that include accountability, altruism, collaboration, compassion and caring, duty, excellence, integrity, and social responsibility. Fundamental to the Standards of Ethical Conduct is the special obligation of physical therapist assistants to enable patients and clients to achieve greater independence, health and wellness, and enhanced quality of life.

No document that delineates ethical standards can address every situation. Physical therapist assistants are encouraged to seek additional advice or consultation in instances where the guidance of the Standards of Ethical Conduct may not be definitive.

STANDARDS

  1. Physical therapist assistants shall respect the inherent dignity and rights of all individuals. (Core Values: Compassion and Caring, Integrity)
    1. Physical therapist assistants 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.
    2. Physical therapist assistants shall recognize their personal biases and shall not discriminate against others in the provision of physical therapist services.
  2. Physical therapist assistants shall be trustworthy and compassionate in addressing the rights and needs of patients and clients. (Core Values: Altruism, Collaboration, Compassion and Caring, Duty)
    1. Physical therapist assistants shall act in the best interest of patients and clients over the interests of the physical therapist assistant.
    2. Physical therapist assistants shall provide physical therapist interventions with compassionate and caring behaviors that incorporate the individual and cultural differences of patients and clients.
    3. Physical therapist assistants shall provide patients and clients with information regarding the interventions they provide.
    4. Physical therapist assistants shall protect confidential patient and client information and, in collaboration with the physical therapist, may disclose confidential information to appropriate authorities only when allowed or as required by law.
  3. Physical therapist assistants shall make sound decisions in collaboration with the physical therapist and within the boundaries established by laws and regulations. (Core Values: Collaboration, Duty, Excellence, Integrity)
    1. Physical therapist assistants shall make objective decisions in the patient’s and client’s best interests in all practice settings.
    2. Physical therapist assistants shall be guided by information about best practice regarding physical therapist interventions.
    3. Physical therapist assistants shall make decisions based upon their level of competence and consistent with patient and client values.
    4. Physical therapist assistants shall not engage in conflicts of interest that interfere with making sound decisions.
    5. Physical therapist assistants shall provide physical therapist services under the direction and supervision of a physical therapist and shall communicate with the physical therapist when patient or client status requires modifications to the established plan of care.
  4. Physical therapist assistants shall demonstrate integrity in their relationships with patients and clients, families, colleagues, students, research participants, other healthcare providers, employers, payers, and the public. (Core Values: Integrity)
    1. Physical therapist assistants shall provide truthful, accurate, and relevant information and shall not make misleading representations.
    2. Physical therapist assistants shall not exploit persons over whom they have supervisory, evaluative, or other authority (e.g., patients and clients, students, supervisees, research participants, or employees).
    3. Physical therapist assistants shall not engage in any sexual relationship with any of their patients and clients, supervisees, or students.
    4. Physical therapist assistants shall not harass anyone verbally, physically, emotionally, or sexually.
    5. Physical therapist assistants shall discourage misconduct by physical therapists, physical therapist assistants, and other healthcare professionals and, when appropriate, report illegal or unethical acts, including verbal, physical, emotional, or sexual harassment, to an appropriate authority with jurisdiction over the conduct.
    6. Physical therapist assistants shall report suspected cases of abuse involving children or vulnerable adults to the appropriate authority, subject to law.
  5. Physical therapist assistants shall fulfill their legal and ethical obligations. (Core Values: Accountability, Duty, Social Responsibility)
    1. Physical therapist assistants shall comply with applicable local, state, and federal laws and regulations.
    2. Physical therapist assistants shall support the supervisory role of the physical therapist to ensure quality care and promote patient and client safety.
    3. Physical therapist assistants involved in research shall abide by accepted standards governing protection of research participants.
    4. Physical therapist assistants shall encourage colleagues with physical, psychological, or substance-related impairments that may adversely impact their professional responsibilities to seek assistance or counsel.
    5. Physical therapist assistants 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.
  6. Physical therapist assistants shall enhance their competence through the lifelong acquisition and refinement of knowledge, skills, and abilities. (Core Value: Excellence)
    1. Physical therapist assistants shall achieve and maintain clinical competence.
    2. Physical therapist assistants shall engage in lifelong learning consistent with changes in their roles and responsibilities and advances in the practice of physical therapy.
    3. Physical therapist assistants shall support practice environments that support career development and lifelong learning.
  7. Physical therapist assistants shall support organizational behaviors and business practices that benefit patients and clients and society. (Core Values: Integrity, Accountability)
    1. Physical therapist assistants shall promote work environments that support ethical and accountable decision-making.
    2. Physical therapist assistants shall not accept gifts or other considerations that influence or give an appearance of influencing their decisions.
    3. Physical therapist assistants shall fully disclose any financial interest they have in products or services that they recommend to patients and clients.
    4. Physical therapist assistants shall ensure that documentation for their interventions accurately reflects the nature and extent of the services provided.
    5. Physical therapist assistants shall refrain from employment arrangements, or other arrangements, that prevent physical therapist assistants from fulfilling ethical obligations to patients and clients.
  8. Physical therapist assistants shall participate in efforts to meet the health needs of people locally, nationally, and globally. (Core Value: Social Responsibility)
    1. Physical therapist assistants shall support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured.
    2. Physical therapist assistants shall advocate for people with impairments, activity limitations, participation restrictions, and disabilities in order to promote their participation in community and society.
    3. Physical therapist assistants shall be responsible stewards of health care resources by collaborating with physical therapists in order to avoid overutilization or underutilization of physical therapist services.
    4. Physical therapist assistants shall educate members of the public about the benefits of physical therapy.
CASE

For the past six months, Rowan has had increasing difficulty in trying to avoid his new neighbor. Ever since she learned that Rowan is a licensed physical therapist assistant, the neighbor has constantly pestered him about her many aches and pains in hopes of getting some free treatment. After the neighbor’s fourth unannounced visit to his home, Rowan finally gives in and agrees to look at his neighbor’s sore neck. After all, he has often watched physical therapists complete cervical spine evaluations and establish treatment plans at the clinic where he works. Rowan examines his neighbor’s cervical range of motion and, finding a limitation in left-sided rotation, he performs some muscle-energy techniques to address this.

Discussion

Has Rowan done anything wrong? Definitely. Rowan has violated two specific standards from the Standards of Ethical Conduct for the Physical Therapist Assistant:

  • Standard 3B: “Physical therapist assistants shall be guided by information about best practice regarding physical therapist interventions.”
  • Standard 3E: “Physical therapist assistants shall provide physical therapist services under the direction and supervision of a physical therapist and shall communicate with the physical therapist when patient or client status requires modifications to the established plan of care.”

As a physical therapist assistant, Rowan is under no circumstances allowed to perform an evaluation on a patient or to select specific treatment options without direct supervision from or in consultation with a physical therapist.