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Alexander Gentile

PTH 695

Dr. Silkwood-Sherer

Ethical Components of the Professional Role

Throughout this semester we have spent a large amount of time focusing on ethical

principles and ethical critical thinking. This time has been allotted to learning about the theory

of ethics due to our impending clinical rotations that will be starting in the fall. Dr. Silkwood-

Sherer has been emphasizing the importance of ethics in physical therapy to protect ourselves but

most importantly to protect our patients. She has put us in different situations, with different

ethical dilemmas, to help prepare us for real clinical situations and how to resolve them

eithically. This practice has forced me to engage in some self-reflection practices to determine if

I practice ethical reasoning and how I define my own personal ethics.

Through self-reflection I have discovered my own set of core values that I use when

delving into the ethical realm. I have found honesty, do no harm, responsibility, compassion, and

integrity to be the foundational values of my personal ethical belief system. To me the most

important of my core values would be honesty. Honesty is most important to me because I am a

very trusting person and take what people say to heart. I naturally believe that people are honest

or want to be honest so I take them at their word. When I talk to an individual I believe they are

telling me the truth and I want to be truthful to them in return. I dont doubt people even if I

havent met them before, unless for some reason they have proven to me they are unable to be

honest. A person who is dishonest diminishes in my eyes as I see them as someone who has low

moral fiber.
The second most important of my core values would have to be my concept of do no

harm. To me this concept is in line with honesty because a dishonesty person is harmful and out

to hurt whomever they are being dishonest with. People that set out to manipulate, steal,

physically harm or take advantage of others are scum. Life is already full of trials, tribulations

and pain that we have to endure without degenerates setting out harm us. The golden rule of

treating others as you would want to be treated is a real sticking point with me. I do not want

any type of injury brought upon me whether its physical, emotional, mental, financial etc. So

in hope of people not trying to harm me I set out each day to be helpful and not harmful to

others.

The next most important core value of mine is responsibility. I believe that everyone is

responsible for themselves and are to be held accountable for their own actions. A responsible

person is someone who considers the consequences of their actions and decides against them if

they will have a negative effect on those around you. We all have a responsibility to each other

to be good neighbors and to do our part for our community. Dependability is a defining

characteristic of a responsible person for me. When an individual tells you they are going to do

something you are then counting on that person to follow through. That can be anything from

making a promise to a friend to accepting a job offer. In both scenarios there are people counting

on you to follow through and put forth the best effort you possible can.

Integrity is my next core value and it goes along the same lines of the previous values I

have already mention. A person with integrity to me is someone who is honest, courageous and

resilient. They are the type of person who doesnt back down from a challenge or run away

when things get tough. A person with integrity is a person who holds their beliefs firmly to their
heart and are uncompromising in the face of adversity. They stand up for what they believe in

and get back up after they have been knocked down.

The last of my core values is to have compassion for others. I have compassion at the

bottom of my core values list because I have a caveat to it. I do believe that the world would be

a better place if we all shared a strong compassion for each other. This falls right in line with my

core values of honesty, do no harm and responsibility. Though the reason I have it last on my list

as least important is because not everyone is deserving of compassion. The old adage fool me

once shame on you, fool me twice shame on me describes my feelings on compassion. I am

open and able to have compassion for complete strangers but when they are dishonest, harmful

or irresponsible my compassion for them dwindles. I am open to giving people second chances

but I am not open to abuse. There is only so far I am willing to go for someone before ties must

be severed.

When comparing my personal core values to those of the American Physical Therapy

Association (APTA) I have found many similarities and some differences. My personal core

values are definitely fewer in number than the APTAs but strike many of the same chords. Three

of my core values are directly in line with three core values of the APTA. The three we have

directly in common are integrity, responsibility, and compassion. In regards to integrity we both

view it as exhibiting honesty in all interactions and being uncompromising when it comes to the

laws or ethical principles that define the physical therapy profession. For responsibility we both

believe that an individual is responsible for their actions and should take responsibility for any

consequences that occur. Also we both believe that handling tasks in a timely and efficient

manner are very important as well as knowing the limits of your own abilities as to not exceed

them. We both believe that active listening and understanding are important aspects of
displaying compassion. Also we believe that empathy is important when interacting with

patients, as well as adapting treatment approaches to provide the best quality care for the patient.

Though I do not have all of the same exact core values of the APTA some of their values

are included within my values as mine are more inclusive and less specific. I find that though I

did not specifically list altruism as a core value of mine I see the APTAs indicators matching up

under some of my core values. The APTA says that providing the necessary time and effort to

meet a patients needs is altruistic but I would categorize it under my compassion and do no harm

core values. I would be displaying compassion by taking the necessary time to provide the best

quality of care while also taking the necessary steps to not harm the patient by speeding through

their treatment. Another APTA core value that I did not list specifically but matches up with my

core values is duty. The value of duty to the APTA is defined as providing the best quality of

care for each patient, to facilitate the achievement of each patients goals and to be demonstrate

the necessary conduct expected out of all physical therapists. The APTAs value of duty falls into

my responsibility and integrity core values. I believe that it is each physical therapists

responsibility to facilitate each patients goal achievement and to provide the best quality of care

possible. I see duty also falling under my integrity value because one need to have integrity to

hold themselves to the proper conduct, behaviors and actions expected out of every physical

therapist.

As a whole I agreed with almost all of the APTAs core values even if I didnt directly

match them or found an indirect connection to my own. Though there are some core value

aspects, not core values that I disagree with. One such aspect that I disagree with is the idea that

we need to be involved in the government under the social responsibility core value. This goes

against my own political beliefs as I think lobbyism and over regulating are big problems in the
government. I agree with have our voices heard but having less restrictions and less regulations

in general is my own personal view point. I also do not whole heartedly agree with the APTAs

continuing competence core value. I do concede that it is important to always be improving and

honing ones craft but I do not agree with degree to which they have taken it.

Since I have developed my own core values and have defined them I have been able to

start applying different ethical theories to them. There are many different ethical theories that

have been taught and reviewed this semester. Some of them I have found appealing and some of

them I found unsuitable for my own personal core values. The theories of ethics are broken up

into two groups consisting of ethics of character and ethics of conduct.

Ethics of conduct are an action oriented group of ethical theories. Their focus is on type

of actions should you as an individual perform. There are three ethical theories that make up the

ethics of conduct group, they are: deontology, utilitarianism and the principle based approach.

Deontology is an ethical theory based on rule selection to determine the morality of actions.

People who follow deontology must follow the right kind of rules so that they perform the right

actions. If their actions end up being wrong it is because they followed the wrong rule set. It is a

very black and white view of morality that does not take into account the consequence of our

actions as long as we followed the right rules. Utilitarianism is the opposite of deontology in that

it takes into account the consequences of actions to determine if an action was ethical. The idea

behind utilitarianism to find action that will have greatest balance of benefits over maleficence.

People who follow utilitarianism see the world in shades of grey, they are able to perform wrong

actions as long as it will provide the greatest benefit to the most people. The last ethics of

conduct theory is the principle based approach that consists of weight the pros and cons of each

action they take. They use ethical principles, that are general rules, to make decisions on good or
bad actions. If the pros out weight the cons then the action is deemed moral and the individual

may have peace of mind. The principle based approach uses four main principles to help weigh

the consequences of their actions and they are: autonomy, beneficence, non-maleficence, and

justice.

The ethics of character theories focus on making person oriented decisions. This group

of theories is focused on what type of person does the individual want to be and how ought that

person behave. Within the ethics of character group virtue ethics and ethics of care are the two

theories that it consists of. Virtue ethics is the theory that focuses on an individuals character to

settle ethical dilemmas and conflicts. This theory states that right actions come from a person

who is virtuous and wrong actions come from a vicious person. To become a virtuous person

you must develop it as if it were a skill. You gain experience and train hard making virtuous

decisions until you become virtuous and it becomes second nature. This consists of using virtues

such as fairness, courage and wisdom to choose right actions. Then to avoid becoming a vicious

person you must avoid vices such as unfairness, cowardice and hot-headedness to prevent

yourself from choosing wrong actions. Ethics of care is a theory that holds interpersonal

relationships as the deciding factor of moral actions. This theory focus on how an individual

interacts with their peers and not on abstract principles to determine morality. If a person is only

looking out for their self and has no regard for other people then they would be selfish and

unethical. Though if a person was compassionate and cared for themselves and other they would

do no harm to anyone and be deemed a very ethical person.

Each of these theories have their strengths and weakness to be more suitable in one

situation versus another. Though some of these theories I have found to be more applicable to a

larger number of situations than others. I have found the three theories I favor most to be ethics
of care, utilitarianism and the principle based approach in descending order of usefulness. I

favor ethics of care the most because it focuses providing the best quality of care possible for my

patient. It forces you to treat each patient a real patient and not just an ailment or injury to be

fixed. It is highly adaptable in the clinic as you are treating each patient different based on their

own personal needs. It is also beneficial on deciding clinical and social policies for care if rules

or regulations are getting in the way of providing the best possible care for the patient.

Utilitarianism is the next most useful theory to me because I dont see things in black and white

but shades of grey. An action may be deemed wrong by a rule or regulation but it results in the

best care for my patient so my ends justify the means. This is very important when it comes to

researching new techniques and strategies for treatment. A treatment could be deemed wrong or

unethical but after researching it and discovering its benefits it could then be viewed as an ethical

treatment. The principle based approach I find good for creating an ethical tie breaker for

solving ethical dilemmas. It allows me to analyze all of the good and all of the bad that each

action I take will create. It helps me to better understand each action I take a not just its overall

effect. I believe that this theory is best implement with patient interactions, determining laws

and deciding social policies. It allows you to see every viewpoint of a given issue and weight the

consequences to create the best treatment, law or policy for the patient.

Physical therapists have a unique role in the interdisciplinary healthcare team. We spend

a lot of time with our patients and get to know them on a more personal level than their doctors

will. We take on the role of the social worker in this aspect as we relate to them on a more

human level then say a doctor who examines the patient for less than ten minutes then leaves.

Then we also have more of a say in the plan of care than a social worker or the nursing staff

does. We are trained to differential diagnose patients to look for medical emergencies and
sometimes treat patients without have a doctors referral. While we generally are not the key

decision maker in creating the plan of care we are high up in the hierarchy while providing the

most hands on personal care second to nurses.

As a physical therapist our specific duties and responsibilities are grouped by patient

care, documentation and differential diagnosing. Our patient care responsibility is to provide the

best possible care to and for the patient. Choosing the most efficient treatments and adapting

treatments to make the patient comfortable is a large part our patient care responsibilities. We

have this responsibility to each individual patient, the patients family and the medical doctor.

We have this responsibility to medical doctors because in most cases we are the alternative to

invasive surgery. If we are not providing the best possible patient care then the patient and the

patients family will be affect as their condition weakens and becomes less independent. These

duties came from the need of providing specialized rehabilitation care that nurses were unable to

provide on top of all their other responsibilities. So physical therapy began from nurses

specializing into rehabilitation specialists that lead to such a hands on heavy approach to patient

care. Our responsibility to documentation is owed to medical doctors, insurance companies,

patients and physical therapists. It is our responsibility to accurately and thoroughly evaluate

every patient while recording all tests, measures, and treatments provided during any interaction.

This allows the medical doctor to accurately analyze, critique and change the plan of care for a

given patient if results from a given treatment are not showing. We owe proper documentation to

the patient and insurance company so that we do not over charge or charge for services not

rendered. This also helps to keep us as physical therapists honest and ethical in making

treatment decision by holding us accountable and justifying each decision made. Lastly our

responsibility to differentially diagnose patients is to the patient and the doctor. Doctors
typically only get a limited amount of time with a patient and may miss some crucial signs or

symptoms for a given disorder. Physical therapists that are able to differentially diagnose are

capable of seeing something a doctor may have missed to provide a double check and relay that

information back to the doctor. Also we spend more time with our patients so they may become

more comfortable with us and reveal key bits of information that they hid from the doctor. Then

its our responsibility to the patient to perform these double checks and gather the necessary

information to make the best decision for the patient.

In regards to our responsibilities as physical therapists there are peoples rights that we

have to consider. One group of people that can affect our job as physical therapists are the

medical doctors. They have the right to over rule us on treatment methods and make diagnoses

that we are not liscensed to make. These rights possessed by the doctors are important because

they are the key decision makers with more knowledge that have to account for all aspects of a

patients healthcare and not just specific individual areas. Also the patients have their own

personal rights that we must acknowledge as health professionals. They have the right to refuse

any treatment that they chose, meaning we must make sure we gain their consent before

performing any evaluation or treatment. This is a very big deal because if we do not gain

consent we can open ourselves up to all kinds of problems such as lawsuits.

This class has done a very good job at helping me expand my view of physical therapy

and all of the responsibilities that I have to myself and other. The importance of ethics was very

murky to me before and just saw it as doing the right thing. Though now that I have a better

grasp on what ethics really consists of I am able to make better decisions as a physical therapist.