Calley Keithler

Ethical Components of the Professional Role

Section 1:

Values are a large component of why we do things and they help guide our ethical decisions.

For these reasons it is key to examine what traits are most important to each individual. Based on my

values assessment, my top values are love, emotional well-being, morality, and health. The values

assessment provided a decent, accurate description of what values are important to me. Love is a

high priority to me because it encompasses family, friendship, and romantic relationships. These are

people who give me love and motivate me to do better. I can share my triumphs and heartache with

those I love, and I recognize I would not be who I am without these individuals.

Emotional well-being and health are closely related. People with poor emotional well-being

often have poor health, because mentality impacts their actions and quality of life; which as a result

impacts their health. Health, specifically good health, is what gives us life and allows individuals to

participate fully in activities. Maintaining and achieving good health can help improve quality of life.

Although there are people who have high quality of life with chronic diseases/conditions, having

health challenges can negatively impact an individual’s daily life. Health encompasses preventative

health measures. Such measures include exercise, proper nutrition, and sleep hygiene. I am proactive

in practicing preventative health measures, because I know the benefits of practicing healthy habits.

The physical therapy field also upholds preventative health measures through high standards of

patient education, which is one of the reasons the field of physical therapy is appealing to me as a

profession.

Finally, morality is one of my values, because it incorporates a number of values within it.

Morality is defined by the Marriam-Webster dictionary as “conduct that conforms to an accepted

standard of right and wrong.”1 Therefore, morality includes responsibility, honesty, kindness, and
correct actions/conduct. Being of moral character means one should hold themselves to certain

standards and act accordingly.

In comparison with the American Physical Therapy Association’s (APTA) core values, my

core values align closely. My values of emotional wellbeing and health are important to physical

therapy, as a health field, and particularly align with the APTA’s core values of caring/compassion

and accountability.2 It is part of a physical therapist’s professional duties to improve quality of life

and functional outcomes of their patients. Physical therapists must also display a level of caring and

compassion in order to assist patients in reaching their goals. When creating plan of cares that are

best for patients’ health, it is crucial to include educational components. Patient education along with

a drive for improved patient outcomes is quintessential of the caring response. It shows that the

interventions administered are not for charging a patient, but rather to improve the patient’s daily life.

Additionally, in situations where patients disclose information such as abuse, physical therapists have

a social responsibility and accountability to report it. This is largely because abusive situations

negatively impact an individual’s health and emotional wellbeing.

Although my core values emotional wellbeing and health are related to the APTA’s core

values, my high value of morality aligns the closest with the APTA. Morality can include these core

values: accountability, altruism, excellence, integrity, professional duty, and social responsibility.

Integrity, in terms of its definition, is the most like morality; both imply adherence to ethical

principles and high moral standards. 2 However, morality is tied to the other values listed, as well,

since morality incorporates a drive to uphold principles. All of the values of the APTA are guidelines

for how a physical therapist should behave, therefore a moral therapist will choose to stand by the

APTA’s core values.2

My top value was love which associated with the APTA’s core value of compassion/ caring. 2

Yet, it is not aligned as closely as my other core values with the professional values of physical
therapy. Love is personal, and it is something you invest into others, just as they invest into you. In

physical therapy, I will care for and develop strong relationships with many of my patients. However,

love is not something that will always be present or reciprocated with every patient. There may be

patients that are a challenge to work with and although I care for them, they might not appreciate the

efforts I put in for their wellbeing. Part of the professional duties of a physical therapist is to continue

to treat patients to the best of his/her ability, no matter who the patient is. The patient should always

be the priority, above feelings and emotions.

Potential conflicts can arise with my value of love, or the APTA’s core value of

caring/compassion. One potential problem can occur if the physical therapist’s well intended actions

are misconstrued as more than a professional relationship. This can occur because physical therapists

spend an extended amount of time with each patient and commonly develop friendships with

patients. The friendship may not pose a problem, but sometimes having a friendship can diminish the

authority and advice of the physical therapist. This is where the professional line needs to be assessed

and the therapist has to recognize the potential consequences of this type of patient-therapist

relationship.

Section 2:

Ethical theories can be broken down into two main categories of ethics of character and

ethics of conduct. First, ethics of character consists of virtue ethics and ethics of care. Virtue ethics

use moral principles to determine the correct behavior in a situation. With virtue ethics, ethical

decisions attempt to create positive outcomes for the decision maker as well as others. Decisions

consider other’s happiness and the virtuous decisions are formed from values that are instilled into

the individual throughout their lifetime. 3 Ethics of care, the other ethics of character, also uses

morality in the decision-making process. However, with ethics of care the emphasis is not on what is

good, but rather uses relationships to help guide decisions. In ethics of care, the matured decision
maker attempts to find a middle ground to obtain the best option for both themselves and others. 3

When using one of the ethics of character, the big difference between virtue ethics and ethics of care

is the perspective one utilizes with each theory. For virtue ethics, an individual looks inside

themselves to decide and uses their moral characters. Whereas, with ethics of care the individual

looks to others, and their relationship, to guide their decision making. However, both these theories

attempt to create an outcome that is “good” or right through their process.

Under the category of ethics of conduct there is utilitarianism ethics and deontology ethics.

Deontology is the process of using established rules to determine actions. While utilitarianism

examines all the potential outcomes, and the course of action is determined through consideration of

the consequences. Once all of the outcomes and their prospective consequences are established, the

individual chooses the decision that is most favorable for the most people. 3 These two types of ethics

of conduct are vastly different ways of thinking. With deontology the outcomes are not considered,

instead the individual only uses a rule/law to guide their decision. The problem with deontology is

sometimes rules can conflict with each other. An example of conflicting rules is the golden rule,

which is the policy of treating others the way that you would want to be treated, and the “eye for an

eye” rule, otherwise known as Hammurabi’s Code. An example where these two rules conflict can be

examined in the case of a starving man stealing a loaf of bread. The golden rule would lean toward

leniency of this man, because he is hungry, while Hammurabi’s Code would inflict a punishment for

stealing. In this scenario, it would be difficult to use Deontology because it does not specify what

rules should take priority.

Although, each ethical theory can lead to different decisions, all of them can be beneficial to

a physical therapist in the clinical setting. An example that many physical therapists will face in their

career is a differing opinion between the therapist and a patient’s physician on the physical therapy

plan of care. For example, a physician may state on the patient’s physical therapy prescription that
they should only receive manual therapy, no exercise. If the therapist performed the initial evaluation

and determined the patient would benefit from therapeutic exercise this could pose an ethical

problem. Using each of the ethical theories, a physical therapist could act differently in their

treatment of the patient. With virtue ethics, the therapist in this situation would utilize the APTA’s

core values of professional duty, integrity, and excellence as the moral principles for how to proceed.

The APTA’s core values would lead the therapist to call the doctor and discuss the benefits of

therapeutic exercise. The therapist would consider it their professional duty to provide the best

treatment to the patient and to advocate for them.

Using the same scenario, with ethics of care, the physical therapist would consider the

relationship they have with the patient in addition to the relationship they have with the physician.

With ethics of care, the therapist would be more cognizant of the referring physician’s guidelines and

approach the situation accordingly. Practicing ethics of care, the therapist would want to give the

doctor details and provide evidence to why the patient would benefit from therapeutic exercise. The

therapist would want the doctor to know their patient is being cared for and that the therapist is not

trying to undermine their prescription or authority.

The utilitarianism approach to this prescription problem would consider what would happen

with each course of action the physical therapist could choose. Some of the options include: call the

doctor, refer the patient to a different therapist, follow the prescription, or treat the patient with

manual and therapeutic exercise. The physical therapist would then go through each of these choices

and consider what problems could occur with each. Calling the doctor could upset the doctor or it

could allow the therapist to treat the patient as they see fit. Referring the patient to another therapist

could take the situation away from themselves; but, if the new therapist follows the physician’s

instructions, the patient might not receive the best care. Additionally, if the doctor had referred the

patient to the specific physical therapist, this could create some discourse with the doctor. Following
the physician’s orders would not be the most beneficial treatment option for the patient, but it would

keep the doctor happy. Finally, treating the patient as the therapists determined the most beneficial

would allow the patient to benefit from therapeutic exercise. However, it would be disregarding the

doctor’s prescription and could cause the therapist to lose a referral source. The utilitarianism

approach would consider what is best for everyone involved and probably decide to try to call the

doctor to get him/her to sign off on therapeutic exercise as a treatment option. This way would try to

keep the doctor happy as well as provide the best treatment to the patient. The other option

utilitarianism could lead the physical therapist to act on, is the therapist could follow the prescription

and do manual therapy incorporating muscle energy or PNF strengthening.

Lastly, using the principles of deontology ethics, the physical therapist in the scenario would

act according to the rules. The possible rules the therapist could employ for this scenario is the rule to

listen to authority or the rule to advocate for their patient. Both rules could lead to very different

results. The listen to authority rule would mean the therapist should follow the physician’s guidelines

and treat the patient as their prescription states. Advocating for the patient would mean the physical

therapist would need to contact the physician and get permission to perform therapeutic exercise

because it is the best treatment option for the patient.

With each of the ethical theories it is evident that an individual can come to similar decisions.

The usefulness of each theory stems from the rationale and the process it takes to determine the best

course of action. Virtue ethics and deontology are more direct. These two theories tend to not focus

on the outcomes as much as the process to determining the decision. Therefore, once the process of

how to solve the ethical problem is decided, the individual would follow through regardless of the

potential outcomes. However, with ethics of care and utilitarianism ethics, decisions are less direct as

many options are considered in accordance with their consequences. With these two theories, it is

recognized many people can be affected by a situation and it is not always clear what is the best
answer. Considering the consequences is what allows the individual to try to obtain the most

beneficial outcome.

For these reasons, I like ethics of care and utilitarianism the best for ethical decision making.

I find ethics of care the most appealing, because it makes the situations more personal. In Teaching

and Learning, over the summer, we discussed conflict management animals. Through this exercise it

was determined that my management style was a “teddy bear.” 4 I identified with the teddy bear style

just like I identify with ethics of care, because they both consider the human relationship as an

important component in resolution. I also, can appreciate utilitarianism as a method of solving ethical

problems. Again, I feel the decision process is deeper and utilitarianism tries to create a solution that

will give the best outcome to a lot of people. This is important because decisions often do not affect

one individual.

For ethical decision making, I would use virtue ethics before I would use deontology. This is

mainly because, in accordance with my core values, I hold morality in high regard. I also think

deontology can create negative outcomes if the wrong rule is employed. Some people say that rules

are meant to be broken, but with deontology ethics it is more that there is an exception to every rule.

Therefore, no matter what principle you try to follow with deontology there always seems like there

is more than one “correct” answer, while the other ethical theories would say the same answer was

“wrong.” This is the reason I would employ deontology last when faced with an ethical problem.

Part 3:

Physical therapists have a unique role in the health professions. Although there are several

occupations that share some similarities, it is the culmination of all of the responsibilities of the

physical therapist that set it apart from others. The physical therapist’s moral role is defined by the

physical therapists’ professional duty, the patient-therapist relationship, and the connection with

other individuals who are not the patient.

 There are many professions that have a responsibility similar to therapist, because they also

share a professional duty to establish relationships with patients/clients. Creating these relationships

typically influence the care and compassion of the professional, due to the deepened connection to

the patient/client. Additionally, part of the rapport formed when working with individuals promotes a

partnership between the professional and the patient. Professions that also possess these same

relational traits as physical therapists are occupational therapists, speech language pathologist,

prosthetists, home health aides, nurses, clergy, teachers, chiropractors, and social workers.

Role related responsibilities of physical therapists include: advocating for patients, improving

functional outcomes, educating patients, providing appropriate skill, and working with patients for

extended periods of time. There are several other professional positions that incorporate these

characteristics as well. Some professions who practice these similarities are teachers, occupational

therapists, physical therapy assistants, home health aides, psychologists, and orthodontists.

Social roles of a profession are also important. The main social responsibilities of a physical

therapist are to work within their scope of practice, make clinical decisions autonomously, establish

partnerships with other providers and vendors, and to adhere to the medical model. Additional

professions that possess these similar role related traits, as a physical therapist, are orthodontists,

chiropractors, and other rehab specialists.

One of the biggest factors to the moral obligations of a physical therapist is the interactions

with others, especially patients. A therapist-patient relationship is unique because often they are

established and meaningful relationships. Relationships are deepened because therapists spend a

significant amount of one on one time with each patient. Time spent with patients is often multiple

times a week and occurs during an ever-evolving time in the patient’s life, as they recover. In order

to assist in optimal recovery, with physical therapy, a team-work relationship is fostered through goal
setting and plan of cares. Meaning the physical therapist ensures interventions are patient-centered,

individualized, and support the patient in achieving their functional goals.

Physical therapists have a responsibility and professional duty, as part of the allied health

science field, to work with a number of different people in addition to patients. These groups of

individuals include: other physical therapists, other health professionals, and society as a whole. Part

of the physical therapists’ professional duty includes communication with the patient, other health

professionals, and co-workers; which is essential to create a high standard of excellence. Specific

duties of therapists, pertaining to communication, include working through plan of cares with the

physician and interprofessional team. The patient’s referring physician must be included with any

plan of care, as it is required that the doctor signs and is in accord with the physical therapist’s plan.

Other medical professionals should also be included in patient care. This is critical, especially in

acute care or inpatient rehab settings, where a patient is seen by several medical professionals each

day. Knowing when a patient received medication is something a therapist should know from the

nursing staff. Additionally, if a physical therapist has positioning or splinting guidelines, all staff

involved with the patient should be aware of the therapist’s recommendation as well as the negative

implications of not following proper instructions. Essentially, the interactions with other health care

professionals or therapists is made in an effort to combine the knowledge and expertise of each field

and create the best patient outcomes through collaboration.

Though physical therapists often act as an interprofessional team, therapists also have to

ability to act autonomously and determine treatment interventions in accordance with the direct

access laws. Therefore, the physical therapist’s duties are obtained through successful completion of

an accredited program, passing the board certification exam, and holding a state license to practice.

These three components allow a physical therapist to practice independently. Yet, this autonomy is

does not mean that the therapist can do only what they think is best. Rather it gives the physical
therapist the opportunity to work with and provide appropriate interventions along with the efforts of

the patient. It also means the therapist should involve/refer out to a medical team, if necessary.

Limiting factors to how a physical therapist practices include: the health of the patient, a

physician’s instructions, a patient’s insurance or income, and a patient’s ability to attend physical

therapy sessions or perform their home exercise program. These limitations in some instances can be

surmountable, while in other situations may pose an obstacle to the physical therapist’s practice. As

examined previously, a physician’s instruction can be limiting, but the therapist has many options for

how to find solutions that will give the patient the best treatment options. With insurance companies

and a patient’s ability to afford therapy, there is always the option to provide pro-bono services.

However, the therapist cannot do this for every patient or they would not be able to stay in business.

This can be a frustrating process as insurance companies do not always have evidence/rationale to

why they cover what they do. Physical therapists have to know the limitations of the patient’s

insurance and provide care that will accommodate to insurance regulations. Finally, physical

therapist should provide proper education for why attending therapy sessions and performing a home

exercise would benefit the patient. This will help avoid potential limitations of patient participation.

Additionally, proper patient education will provide a better understanding of their condition. From

these examples, it is apparent there are many complex roles and responsibilities a physical therapist.

However, each duty of a physical therapist exists to guide actions and decision-making processes for

the delivery of the best possible physical therapy.

 References

1. Morality synonyms, morality antonyms. Marriam-Webster. https://www.merriam-

webster.com/thesaurus/morality. Accessed March 8, 2019.

2. American Physical Therapy Association. Professionalism in physical therapy: core values. APTA

website.

https://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BOD/Judicial/Professional

isminPT.pdf. December 14, 2009. Accessed February 22, 2019.

3. Purtilo RB & Doherty RF. Ethical dimensions in the health professions. 6 th ed. St. Louis, MO:

Elsevier; 2016.

4. Plack MM & Driscoll MA. Teaching and learning in physical therapy: from classroom to clinic.
2nd ed. Thorofare, NJ: Slack Incorporated; 2017.