Introduction to Ethics PDF

Introduction to Ethics By Dr Joseph Wageeh Saweres Lecturer of physical therapy Basic science department and biomechanics Suez canal university  Objectives By the end of this lecture you should be able to: -Understand what is meant by “E...

Introduction to Ethics By Dr Joseph Wageeh Saweres Lecturer of physical therapy Basic science department and biomechanics Suez canal university  Objectives By the end of this lecture you should be able to: -Understand what is meant by “ETHICS” -Ethics in physical therapy -The History of Ethics -The nature of Physical Therapy -The scope of practice -Importance of ETHICS at different levels “individual level, professional level and organizational level” -Qualifications of Physical Therapist -Difference between “ETHICS and MORALS” - Code of ETHICS and Code of CONDUCT -Know and understand the core values of the profession of physical therapy Assessment method Time Marks Grade weight (%) Written exam 2 60 60% Practical exam 0 0 Oral exam 0 0 Mid-term exam 20 20% Attendance 10 10% Assignment and class 10 10% work and activity  What is meant by ETHICS? The word “ethics” is derived from the Greek word ethos (character), and from the Latin word mores (custom). Together, they combine to define how individuals choose to interact with one another.  Ethics defines what is good for the individual and for society and establishes the nature of duties of people toward themselves and one another. Ethics also examines the bases of human goals and the foundations of “right” and “wrong” human actions to achieve these goals.  Ethics in physiotherapy can be defined as the moral code of conduct that defines the relationship between the therapist and her patient, and the therapist and other healthcare professionals based on mutual respect and trust.  The History of Ethics Put in the context of the development of ethics, bioethics goes back to ancient times. Joined with the development of medicine and the medical profession it goes back to the oath of Hippocrates. In 1803 a work called Medical Ethics by T. Percival was published, in which the author sought a proper solution for the relationship between physician and patient  People became aware of the need to make a philosophical-moral reflection on the new possibilities open to the biological and medical sciences in full after the Second World War, in the course of which the latest medical accomplishments were used in the genocide of millions of people.  The first important moral reaction to these crimes was the Universal Declaration of the Rights of Man on December 10, 1948 by the General Assembly of the United Nations. Bioethics as a new discipline appeared somewhat later  In the 1960s there was a rapid development in the biological sciences and extraordinary technical progress based on those discoveries. In 1970 van Rensselaer Potter, an oncologist with the University of Wisconsin in Madison (USA), used the term “bioethics” for the first time in his moral reflection on the biological and medical sciences and reflected on the methodological foundations of a separate discipline Ethics are important on several levels: People feel better about themselves and their profession when they work in an ethical manner. Professions recognize that their credibility rests not only on technical competence, but also on public trust. At the organizational level, ethics is good business. Several studies have shown that over the long run ethical businesses perform better than unethical businesses.  The nature of Physical Therapy: Physical therapy is services provided by physical therapists to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan.  Physical therapy involves the interaction between the physical therapist, patients, other health professionals, families, care givers and communities in a process where movement potential is examined/assessed and goals are agreed upon, using knowledge and skills unique to physical therapists.  Treatment and Rehabilitation usually occur in settings which may include but are not confined to the following:  Hospitals. Nursing Homes. Rehabilitation Centers. Physical Therapist Private Clinic. Out-Patient Clinics. Community Settings: Primary Health Care Centers: Individual Homes. Physical therapists are concerned with identifying and maximizing quality of life and movement potential within the spheres of:  1- Promoting the health and well being of the individual and the general society 2- Preventing impairments, functional limitations and disabilities in individuals at risk of altered movement behaviors due to health or medically related factors, socioeconomic stressors and lifestyle factors  3- Providing interventions to restore integrity of body systems essential to movement, maximize function and recuperation, minimize incapacity and enhance the quality of life in individuals and groups of individuals with altered movement behaviors.  The scope of practice The scope of practice is the area or areas of your profession in which you have the knowledge, skills and experience to practice lawfully, safely and effectively, in a way that meets the standards and does not pose any danger to the public or to yourself.  Physical therapists’ professional scope of practice consists of patient management including diagnosis and prognosis to restore, correct, maintain, and maximize physical function, movement,  performance, health, quality of life and to prevent, minimize and mitigate the effects of disease, injury, congenital abnormalities, as well as other health conditions during the patient lifespan.  The Physical therapist’s scope of practice will change over time and that the practice of experienced therapist often becomes more focused and specialized than that of newly registered colleagues.  This might be because of specialization in a certain area or a particular group has roles in management, education or research. Examples from physical therapy scope of practice: 1- Examining (history, system review and tests and measures) individuals in order to determine a diagnosis, prognosis and intervention within the physical therapist's scope of practice.  2- Evaluation is then conducted to interpret the findings and establish a diagnosis and prognosis that includes a plan of care in order to determine a diagnosis, prognosis and intervention. 3- Treating impairment and functional limitation by designing, implementing and modifying therapeutic interventions  4- Preventing injury, impairment, functional limitation and disability, including the promotion and maintenance of fitness, health and quality of life. 5- Engaging in consultation, education, and research. The scope of physical therapist practice is not limited to direct patient care, but also includes:  public health strategies supervising and delegating to others leading managing teaching research  Qualifications of Physical Therapist There are essential requirements which are the base to form a qualified physical therapists. These qualifications of are:  1- Knowledge: the physical therapists must have a good average of knowledge in different sciences (anatomy, physiology, histology, pathology, biomechanics, basic sciences of physical therapy) in addition to all modalities of physical therapy.  2- Good communication skill: physical therapists must have skill of communication to other members of medical profession to achieve the goal of medical team. 3- Cooperate with team work looking forward for the patient beneficences.  4- Time Respect: physical therapist should respect his timetable of his work, clinic and private cases. 5- Honest: the physical therapist must be honest, telling the truth not cheating or stealing. This is concerned with his opinion, statement, job, service, practice, …etc  6- Patience: the physical therapist must have the ability to bear delay, annoyance or suffering from patients and others without complaining. 7- Tact: the physical therapist must have the ability to say or do the right thing at the right time with patients and others.  8- Creation: the mental process of forming an idea and creating a problem solving items to the patient's complaint. 9- Enthusiasm: physical therapist must enthuse. 10- Desire to help: the physical therapist should have the desire to help the others especially patients to achieve the benefits of the treatment.  11- Power of observation: the physical therapist must be a good observer to pick up the patient's problem at the first look and visit and observe any unusual changes or new symptoms revealed during application of treatment modalities. 12- Emotional State: the physical therapist should adjust and control his emotional reactions toward patients, i.e. he can show sympathy with patient's problems but not involve himself in this problems.  13- Physical fitness and endurance: the physical therapist must be fit physically to phase the professional demands and he must have the endurance to tolerate the needs of his work. 14- The physical therapist should follow the code of ethics of his profession. Physical therapist should differentiate between clinical and ethical decision making.  Professionalism Professionalism in physical therapy describes seven professional behaviors that expected to be present in Physiotherapy graduate.  Professionalism in Physical Therapy (Core Values): 1- Social Responsibility: the physical therapist participates in efforts to meet the health needs of people locally, nationally or globally. 2- Professional Duty: the physical therapist fulfills their legal and professional obligations. Have primary responsibility for treatment, supervision and research.  3- Excellence: the physical therapist enhances their experience through the lifelong acquisition and improvement of knowledge, skills, abilities, and professional behaviors, and achieve and maintain professional competence.  4- Compassion & Caring: the physical therapist acts in a respectful manner toward each person regardless of age, gender, race, nationality, religion, social or economic status, health condition or disability. He collaborates with patients to empower them in decisions about their health care.  5- Integrity: The physical therapist demonstrates integrity with patients, families, colleagues, students and research participants. He must not harass anyone verbally, physically or emotionally. He must protect confidential patient information.  6- Accountability: The physical therapist should obey laws and regulations. He shall be accountable for making correct professional decisions within their scope of practice and level of experience and shall communicate with, collaborate with, or refer to colleagues or other health care professionals when necessary.  7- Altruism: The physical therapy act in the best interests of patients over his interests.  Ethics versus Morals Although the terms “ethics” and “morals” are often used interchangeably, they are not identical.  Morals “values”: are influenced by religion, culture, and society. They are the core of personality, behavior and attitudes. Ethics: are influenced by professions, organizations and institutes.  Moral values can occur at many different levels as: Personal morality Group morality Societal morality Ethics Morals Moral Values  What is “Code of ETHICS”? Code of Ethics refers to a set of guidelines provided by top-level management to provide the acceptable behavior in members with in an organization, association, or profession.  Code of ethics is a standard of morals by which a company “profession” makes decisions about what is right or wrong. Therefore, a code of ethics in a company “profession” helps its employees to understand the difference between right and wrong and use that understanding to make decisions.  The code of ethics includes values and principles of the company “profession”, and how the company “profession” plans to use them to guide employees “members” for ethical standards and how to achieve them to know what is right and what is wrong.  In brief, the code of ethics helps companies “professions” to conduct business with honesty and integrity.  Code of Ethics for the Physical Therapist The Code of Ethics for the Physical Therapist (Code of Ethics) describes the ethical obligations of all physical therapists as determined by the American Physical Therapy Association (APTA).  Code of CONDUCT Code of conduct is a set of rules and regulations that explain the acceptable behavior in a specific situation. A code of conduct in accompany explains how professionals must act within the organization. It determines what appropriate behavior and inappropriate behaviors.  General examples of the areas it covers include: Work environment –equal opportunity, policies about harassment, substance abuse, violence, safety, etc. Protecting the company’s resources –protecting intellectual property, use of company resources, information security, etc.  Conflicts of interests – insider trading, taking out loans, etc. Attendance and punctuality Anti-bribery and corruption  The purposes of this Code of Ethics are to: 1. Define the ethical principles that form the foundation of physical therapist practice in patient/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 and students, and allow other health care professionals, regulators, and the public to observe 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. Ethical dimensions in professions are needed to 1. have clear boundaries 2. have commonly accepted norms of behavior 3. enhance respect within and outside the profession 4. protect the rights of the consumer/ client 5. protect the rights and privileges of the professional  Ethical dilemmas arise every day in clinical practice and it might be challenging to find a good solution or compromise that respect all viewpoints, values and duties of every person and/or an institution involved. They can present in many ways, for example:  inter-personally between patient and therapist intra-personally with an internal struggle inter-professionally within the interdisciplinary team or institution we are working with an organization, intra-organizationally or even in dealing with hot topics on health- or socio-political fields.  For good ethical clinical decision making, healthcare practitioners should utilize a good knowledge of basic ethics which includes an understanding of the underlying basis for ethical principles such as respect for autonomy and justice, as well as a reflective knowledge of the influence that one's personal beliefs and values might exert in the decision-making process.  Four principles of medical ethics: Autonomy – The right for an individual to make his or her own choice. Beneficence – The principle of acting with the best interest of the other in mind. Non-maleficence – The principle that “above all, do no harm,” as stated in the Hippocratic Oath. Justice – A concept that emphasizes fairness and equality among individuals  This Code of Ethics is built upon: a) The 5 roles of the physical therapist (management of patients/clients, consultation, education, research, and administration) b) The core values of the profession c) and the multiple levels of ethical action (individual, organizational, and societal).  ETHICAL PRINCIPLES of Code of ETHICS There are 8 principles of Code of ETHICS will be discussed later in that course, with each principle is based on and requires specific core values.  The interpretations of these principles expressed later are not to be considered all inclusive of all the situations that could evolve under a specific principle of the Code but reflect opinions, decisions, and advices in common cases and conditions.  Physical therapists are encouraged to seek additional advice or consultation in instances where the guidance of the Code of Ethics may not be definitive.  Core values Physical therapist practice is guided by a set of 7 core values: 1-Accountability 2-Altruism 3-Compassion/caring 4-Excellence 5-Integrity 6-Professional duty 7-and social responsibility. Principles of medical ethics  Definition: They are fundamental concepts judge the people behavior. These principles help individuals make decisions and serve as criteria to measure the people rightness or wrongness of behavior.  Autonomy Respect patient right to independent decision making  When applied autonomy in physical therapy practice: Inform clients about options of treatment and risks Respect and accept their decisions Implement interventions chosen by clients. Respect and hold in confidence client’s personal information.  Beneficence Doing what is best and right to benefit patient  When applied beneficence in physical therapy practice: Provide appropriate interventions to advance the treatment plan Accurately evaluate the effectiveness of an intervention. Maintain professional competence.  Non maleficence Duty to do no harm or allow harm to a patient through neglect.  Justice It implies fairness and equality to all patients  When applied justice in physical therapy practice: Attend to the needs of patients, regardless their personality, disability, race, gender, age, or lifestyle. Deal fairly and equally with all patients Respect for human life and dignity Individuals be treated as unique and equal to every other individual.  Veracity (truth telling): Provide trustful information. It is the mutual between physiotherapist and patient  Confidentiality Do not share information