improper conduct_ case one

8/12/2019 Improper Conduct_ Case One

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b y N a n c y R K i r s c h l> T D F T P h D

A m a t t e r a f i n t e r v e n t io n .pride ourselves on being

a caring, hand s-on profes-sion, but what happens when

the physical contact may be inappropri-ateregardless of the instigator? Thismonth, we begin a series of three columnson issues of improper conductsexuallytinged impropriety in particular. The sub-ject will be approached from three differ-ent perspectives, but each case will requiremaking a judgment about the behavior.

As you read, use the Realm-IndividualProcess-Decision M akin g (RIPS) m odel ofethical decision-making' to decide if thebehavior is inappropriate and if those wh obecome aware of the behavior have ethicalchallenges they must address.

After reading the following scenar- o look a t the accompanying boxesComponents of the RIPS Model (belowright) and the APTA Code of Ethics onpage 36consul t the Ethics in Act ioncolum n Eth ica l Dec i s ion Mak ing:Terminology and Context , ^ and use theguiding questions within each of the stepsto ethical decision-m aking to help crystal-lize your thoughts.You are in the office working on yourdocumentation and overhear two of yourcolleagues, Bob and Jim, talking about apatient Bob had seenthat moming (Theyare speaking in hushed tonesand clearlya reunaware you can hear them.) Bob describesthe patient a s having been young and pretty,and offers Jim details of his thorough evalu-ation of her cervical spine and thoracicarea.He says she was a verycooperativepatientwho disrobed and put on a gown as he haddirected at the beginning of the evaluation.

She did appear to be a little u ncomfortable.Bob tells J i m , but Bob assured her that thissimply was part of a thorough evaluation.

Bo bgoeson to say that after his completeassessmentof h er cervical spine he palpatedher breasts, telling her that mam mary mas-sage has been shown to alleviate cervicalpain. Jim expressessurprise that the patientwas so compliant, whereupon Bob ff-gglesand facetiouslynoteshis w a y with women.N o , seriously. Bob continues, mam marymassage is a theoretical concept hed heardmentioned during a course he'd taken a

few months before. He'd been intrigued bythe idea at the time. Bob says, but co uldn'timagine ever actually employing it on apatient.

But that m orning's patient. Bob says,seemed t o be the perfect individual o n whichto try the technique, as she d beensent to theclinic by a nearbystateresidential facility forpeople with developm ental disabilities. It'sunlikely Bob tellsJim, that she'll men tion

his choice of intervention to anyone anit's questiona ble, at any rate, whether anyone would take serious stock in what shs id Bob emp hasizes to Jim that this waa one-time, spur-of-the-moment action thahe has no intention of repeating with another patient.

Bob then leavesthe room to treat anothpatient Shortly thereafter Jim looks at youand can tell from the uneasyexpressionyocan't quite wipe o ff your face that you overheard m ost if not all of the conversation. Jimsaysin a calm, steady voice, Y o u heard B oIt was a one-shot thing that won't happeagain. Just let it g o . Y o u are left to consideyour options.

Step : Recognize and Define theEthical IssueAskyourself Into which realm or realms does this

situation fall: individual, organiza-tional/institutional, or societal?

omponents of theRealmIndividual relationshipbetween individuals)Organizational/Institutional good of theorganization)Societal confimon good)

RIPS Mo de lIndividual ProcessMoral Sensitivityrecognize situation)Mo ral Judgmentright or wrong)Moral Motivationmoral values aboveother values)Moral Courageimplement action)

Ethical SituationIssue or Problem valuesare challenged)Dilemma right v s rightdecision)Distress righ t courseof action blocked bya barrier)Temptation right vs wro ngsituation)Silence values arechallenged but no oneis addressing it)


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W hat does the situation require ofyou? W hich individual process is mostappropriate: moral sensitivity, m oraljudgment, moral motivation, or m oralcourage? Are there implications foraction on the parts of anyone besidesyou?Bob Jim?

W hat type ofethical situation is this:a problem , dilemm a, distress, ortemptation?

Are there barriers to you doing whatyou think you should do?

Step : eflectAskyourself W hat do you know about the patient?How serious is her cognitive impair-

ment? Has yourfecilitypolicies regard-ing PTs treating patients oftheoppo-site gender?

W ho are the major stakeholders? In

addition to you and your colleague,who or what else may be affected bythis situation?What are the potential consequencesof your action or inaction?Might your action or inaction breakany laws?What ethical principle or principlesmay be involved? D o any ofthefol-lowing resources provide professionalguidance: the APTA Code of Ethics,the APTA Guide for ProfessionalConduct,^ and/or Professionalism inPhysical Thera py: Core Values? * Forexample, do you see a relationshipbetween this case and principles 1, 2,and 9 of the APTA Code of Ethics?Do other principles strike you as per-haps being applicable? Wh ich do youfeel apply to you and which apply toBob and/or Jim?

Finally, consider how this scenariostacks up against the tests posed byRushworth Kidder in How ood PeoplMake ToughChoices ^: legal, stench, fronpage,mom, and professional ethical vio-lation. In other words: Is somethingillegal going on? Does the situation feelwrong? Would you feel uncomfortablewere the details of the situation (includ-ing your inaction, if you chose not todo anything) to become public? Whatwould your mother/parents do if facedwith similar circumstances? Can youdetect any ethical violations within theAPTA resources listed previously?Step 3: DecidetheRightThing toD o

If the scenario fails any of the testsdescribed in the previous step, this step issuperfluous. In that case, action must betaken; the questions become what kind of

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acdon, and do you have the moral cour-age to implement it? In making thosedeterminations, in turn, consider the con-sequences of inaction, and whether col-lateral damage could result from eitheracdon or inaction.

If, however, you believe the scenariopasses each of Kidders tests, it's timeto look at the three possible approachesKidder presents for determining the rightthing to do, and also to look at whetheryou foresee any barriers to implementingyour response: Rule-based: Follow only the principle

you w ant everyone else to follow. Ends-based: Do whatever producesthe greatest good for the greatest num-

ber of people. Care-based: Do unto others as you

would have them do unto you. (The"Golden Rule.")Ask yourself a s well: Are there are any

potential barriers to implementing yourdecision? Are there ramificadons for the

clinic, your colleagues, and/or current andfuture patients?Step : Implement Evaluate eassess Having determined in your own mindthe right thing to do and the best way toimplement your decision, reflect on thecourse of acdon you've chosen and thinkabout whether a change in your clinic'sorganizational policy or culture might pre-vent this scenario from recurring.

Again, this month's column is the firstin a series on issues related to matters ofsexual impropriety. This column arc willconclude in September's issue with ananalysis of all three cases. In the m eantim e,please let me hear from you (Note mye-mail address.) Tell me your thoughtsabout these cases^your resolutions andhow you arrived at them. A nd please shareyour insights with other PTs and PTAs,

, as well. Use Ethics in Action as a teachingtool, as many of your colleagues across thecoun try are already do ing. (^N a n c y R K i r s t h F T , D P T P h D a m e m b e r o f A F I A s E t h ic s a nJ u d i c ia l C a m m i tt e e , i s a n o s s o d o t e p w f e s sa r o f p h y s i c a l h ra p y h U n i v e i s it y o f M e d id n e a n d D e n t i s t r y s S f io o o f H e a l th R e l a tP r a f e s a o n s in H e m r k , N e w J e r s e y , a n d a p a r t n e r in N o r th e m HP h y s i c a l T h e r a p y A s s o c i a te s in f l a n d e r s , N e w J e r s e y . S h e c ac o n t v c t e d a t k i r s c h n a @ u m d n j . e d u .

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Swisher LL, Arslanian LE, Davis CM . The re alm-ind ividual process-situation (RJPS) model opethicil decisionmaking. HPA Resource 2OO5;5(3):1 3-8.Kirsch NR. Ethical decision making; terminolog)' and context. PTM agazine of Physical Therapy. 2006 ; l4 (2 ) :384 0 .

3 . Americ an Physical Ther apy Association. APTA Guid e foProfessional Conduct. Available at www.apra.org/AMTemplate .cfm?Section=Ethics_and_Legal_Issues & C O NT E N T I D = 2 ' i 7 8 1 & T E M P L A T E = / C M / C o n t e n t D i s p l a ycfm. Accessed February 21, 2007.

4 . American Physical Ther apy Association. Professionalism inPhysical therapy; Core Values. Available at www.apta.otgAM/Template.cfm?Section=ProfessionaIism &:Template=T a gge d Pa gc /T a gge dPa ge D is p la yc fm&T PU D = 97& C on tentID= 2126 3. Accessed February 21, 2007.Kidder RM. H ow Good People Make Tough ChoicesResolving the Dilemmas of Ethical Living. New York, NYFireside. 1995.

APTA Code of Ethics HOD 06- 00- 12- 23)PreambleThis Code of Ethics of the AmericanPhysical Therapy Association sets forthprinciples for the ethical practice of physi-cal therapy. All physical therapists areresponsib le for mainta in ing and pro-moting ethical pract ice. To this end thephysical therapist shall act in the bestinterest of the patient/client. This Codeof Ethics shall be binding on all physicaltherapists.Principle 1A physical therapist shall respect the rightsand dignity of all individuals and shallprovide compassionate care.Principle 2A physical therapist shall act in a trustwor-thy manne r toward s patients/clients an din all other aspects of physical therapypractice.

Principle 3A physical therapist shall comply withlaws and regulations governing physicaltherapy and shall strive to effect changesthat benefit patients/clients.Principle 4A physical therapist shall exercise soundprofessional judgment.Principle 5A physical therapist shall achieve andmaintain professional competence.Principle 6A physical therapist shall maintain andpromote high standards for physical ther-apy practice education ond research.Principle 7A physical therapist shall seek only suchremuneration as is deserved and reason-able for physical therapy services.

Principle 8A physical therapist shall provide andmake available accurate and relevantinformation to patients/clients about theircare and to the public about physicaltherapy services.Principle 9A physical therapist shall protect thepublic and the profession from unethicalincompetent and il legal acts.Principle 10A physical therapist shall endeavor toaddress the health needs of society.Principle 11A physical therapist shall respectthe rights knowledge and skills ofcolleagues and other health careprofessionals.


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improper conduct_ case one

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