Ethics Case Presentation

By: Kaitlyn Bigner, Holly Lochtefeld, Trey Staton, Tessa

Stewart, and Ian Watson
 Summary of Case - Instructive Query

Can Physical Therapist be compelled to provide clinical education? Should they be?

● Bruce is the new Lead-PT at The Rehabilitation Institute, an institute known for excellent student
training.
● Upon the promotion, Bruce learns that unlike his personal goals to expand the clinical instructors
presence for the physical therapy department, many of his colleagues do not want to take on student
physical therapists because they feel as if they will burnout faster, lack the time, overwhelming
questions from the students, and the interference with proper care to the patient.
● Bruce looks to the physical therapy core ethical document to determine his next steps.
Perspectives of Varied Theories

● Utilitarianism
● Principlism
● Virtue Ethics
● Liberalism
● Deontological
Utilitarianism
● Utilitarianism: The greatest good for the greatest number of people
● Application: What would happen if there were a requirement for CI’s in this clinic?
○ Benefits:
■ The patient and student benefits from CI’s in the clinic since the student is
learning the best care/is having their questions answered.
■ The patient indirectly benefits since the student is learning the best care for the
patient.
■ The CI may also benefit by explaining and justifying their clinical reasoning to
SPTs. By teaching students constantly, they are solidifying their skills and
learning at the same time.
○ Poor outcomes:
■ The PTs who would be overwhelmed with a SPT could provide poor care to their
own patients

*More patients would still benefit since the future of our profession-the SPTs are enhancing their skills*
 Principlism
● Principlism:
○ General guidelines that allow room for judgement and discussion in specific cases and provide significant guidance
for expanding into varie, detailed rules and policies
○ Main constructs of principlism: autonomy, nonmaleficence, beneficence, and justice

● Application to the Instructive Query:

○ Bruce allowed room for judgement and discussion through open conversations with the current physical therapist in
his rehabilitation center and surveys to learn previous student acceptance among the practicing physical therapist
■ Autonomy: allow practicing physical therapist to choose if they would like to be a clinical instructor
■ Nonmaleficence: promote full attention to the patient in order to facilitate proper treatment without harm
■ Beneficence: to benefit future physical therapists through hands on learning while also promoting continuing
education for the clinical instructors
■ Justice: to allow choices for practicing physical therapist but also fairness to the future physical therapist to
promote and expand upon their learning
Virtue Ethics

● Virtue Ethics:
○ We do what is right based on our moral character
○ What is right can vary by situation

● Application:
○ PTs feel like becoming a CI is something that is right and required of them
○ Reasoning for not becoming a CI varied
■ Some thought it was a burden
● Didn’t want to “hold the students hand”
● Claim students “ask to many questions” and their education is not sufficient
■ Some thought it may affect care to their patients
○ Every PTs situation changes whether or not it is “right” to become a CI
Liberalism

Theory

● Everyone has the freedom to make their own decisions

● “Individuality without interference”

Ethics case

● Does the PT have the right to choose to be a CI?

● The organization or “governing body” should not make the decision for the PT

PT Code of Ethics

● 7F. Physical therapists shall refrain from employment arrangements, or other arrangements, that prevent physical therapists from
fulfilling professional obligations to patients and clients.
● Should they take on the student if it interferes with the quality of care?
Deontological

● Deontological:
○ Decisions should be made based on what is right and should be selfless.

● Application:
○ Currently, TRI has many PTs who are not following these ethical standards because their reasoning for not
becoming a CI are selfish
○ It is the right decision for all of the PTs in the clinic to take on a student, and the PTs personal situation
should not impact whether or not they have a student or not
○ This responsibility is outlined in the APTA code of ethics, and this would stand as the universal maxim
■ Therefor, each PT is duty-bound to provide clinical education to students even if it is not what they
wish to do
Problem Solving Process - RIPS
● Realm:
○ The institutional/organizational realm is concerned with the good of the organization and focuses on structures and systems that
will facilitate organizational or institutional goals.
○ The individual realm is concerned with the good of the patient/client and focuses on the rights, duties, relationships, and
behaviors between individuals.
● Individual Process:
○ Courage: Bruce is faced with the challenge of implementing a plan in which either way he will face adversity. If he does not
require each PT to take on CI, he could face backlash from his supervisor. If he does require it, as a PT lead he will face backlash
from the other PT’s in the department. Needs moral courage to implement his decision.
● Ethical Situation:
○ Dilemma: Bruce is challenged to decide to side with the physical therapist values to not take on a student physical therapist in
order to provide the best care for the client with their allotted workload vs. physical therapist values to include student physical
therapists into the practice to benefit student learning and promote clinical instructor continuing education.
 Application to PT Code of Ethics
● Principle #2: Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients and 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 and clients
over the interests of the physical therapist.

● Principle #6: Physical therapists shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills,
abilities, and professional behaviors (Core Value: Excellence).
○ 6D. Physical therapists shall cultivate practice environments that support professional development, lifelong learning, and
excellence.

● Principle #7: Physical therapists shall promote organizational behaviors and business practices that benefit patients and clients and
society. (Core Values: Integrity, Accountability)

○ 7F. Physical therapists shall refrain from employment arrangements, or other arrangements, that prevent physical therapists from
fulfilling professional obligations to patients and clients.
Conclusion
● Bruce will work to enhance his clinic by creating a more organized clinical education environment
through a “business model.”
● The interview process for prospective PTs will include a section that discusses the importance of
CIs and evaluate prospective PT’s interest in clinical education.
● Bruce will require that the clinic has a certain percentage of CIs to continue the education of our
future’s professionals
● A PT will never be forced to become a CI, but the amount PTs who do not want to be a CI because
they don’t want the burden of a SPT/hindrance in their work load would hopefully decrease due to
the new model:
○ PTs who take on SPTs will have their patient workload applied to a model that assigns them
the “best” number of SPTs for that workload.
○ Based on the amount of SPTs interested in the clinic, the clinic will have a certain
percentage of CIs.
References

http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Ethics/CodeofEthics.pdf#search=%22code%20of%20ethics%22