INTRODUCTION TO

PHYSICAL THERAPY
PROFESSION ETHICS AND
LAWS
Dr/ Alshaimaa Alsayed Ali
Lecturer in internal medicine and geriatrics department
Faculty of Physical therapy GIU university
Table of contents

What is physical Definitions of

01 therapy?
02 ethics

Ethics, morals Principles of

03 and laws
04
ethics
 Introduction
Physical therapy is providing services to
people to develop, maintain and restore
maximum movement and functional
ability throughout the life span.
The clinical practice of physical therapy
includes assessment, diagnosis, planning,
intervention and reevaluation to achieve
the highest possible level of independent
function.
 Physical therapist in Egypt registered in,
graduated from and trained in
1. Faculties of physical therapy
2. General Syndicate and collaterals of physical therapy
3. Departments in Universities, Ministry of Health,
Ministry of Defense and Police Hospitals
4. Departments in Private Hospitals, private clinics-sports
centers
5. Nursing homes
Areas of specialty in physical therapy:
 1-Cardiovascular and pulmonary
 2-Geriatric

 3-Wound management
 4-Neurology

 5-Orthopaedics and sport injuries

 6-Pediatrics

 7-Women's health
Definitions of
ethics
■ According to Webster's dictionary ethics is a concept that deals with
moral issue of good and bad, based on social norms.

■ Ethics are The Beliefs of Physical Therapists.

■ Ethics is also "A field of human inquiry that examines the basis of

human goals and the foundations of right and wrong human actions that
further or hinder these goals
 IMPORTANCE OF ETHICS:
 Therapists 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 a good business. Several

studies have shown that over the long run ethical businesses
perform better than unethical businesses.
 Why do we
Study Physical
Therapy Ethics?
● To identify and clarify moral issues and moral reasons
● Forming consistent and well-developed moral perspectives
● Society judges a profession largely on the ethical behavior of its
members. It is therefore important for professions to assure the
public that their members act in an ethical manner
● Ethics decides; a. What is right and what is wrong. b. How to live
a good live. c. Our rights and responsibilities. d. Moral decisions.
Ethics and
Morals
● Although the terms “ethics” and “morals” are often used
interchangeably, they are not identical.
● Ethics refer to rules provided by an external source, e.g., codes
of conduct in workplaces or principles in religions. *The
formal study of moral*. Its source is Social system/external
because society says it is the right thing to do.
● Morals refer to an individual's own principles regarding right and
wrong. Its source is Individual / internal Because we believe in
something being right or wrong.
● A person strictly following Ethical Principles may not have any
Morals at all
Ethics and
Laws
● Some actions are NOT against ethics may be illegal, e.g., driving
fast, using hospital equipment to treat patient without official
papers.
● Ethics and morals are very simple and not complex.
● We punish people who violate ethical or moral standards by
expressing our disapproval or refusal of their act
● Laws are some actions that are unethical may be legal, e.g.,
releasing secret.
● Laws can be unethical or immoral, e.g., Nazi’s laws.
● Laws are often expressed in highly technical and complex
expressions, and we need specially trained people (lawyers and
judges) to explain them.
● Laws are enforced by the government. People who break laws can
be punished, i.e., fined, imprisoned or executed.
Types of ethics
 1.Descriptive ethics: It describes what people in the society
actually believe to be right or wrong, not how things should
be. Describe people moral beliefs, claims, behavior, etc.
• Studied primarily by psychology, sociology,…
2. Normative ethics: determines the general moral standards
that should be followed to have a morally right human
behavior OR it determines how thing should be [which
actions are in fact right or wrong/good or bad.
• Studied primarily by philosophy, theology
 3. Applied or professional ethics:

• Definition: Professional ethics are standards of conduct

apply to people who practice certain profession.
• Those who practice certain profession should acquire ethical
obligations because the society trusts them to provide
certain level of service based on the professional standards.
• Examples: bioethics, medical ethics, clinical medical ethics,
…….., etc.
• Bioethics: is the study of moral issues and decision-making, associated
with the use of living organisms in biological sciences. It includes
medical ethics and environmental ethics.

• Medical ethics are moral principles that apply to people who practice
medicine, and concern issues of medical practice. It is a type of applied
ethics that helps doctors to decide what is morally right. It is necessary
in medicine because; Doctors are dealing with patients’ lives. They
have the power to cure as well as the power to kill.
Ethical principles:
Autonomy Nonmaleficence

Beneficence Justice
1. Autonomy
● is patient’s right to make his own choices and take actions without
harming or violating the rights or interests of others (Independent
decision making).
● To be able to make a decision, the patient has the right to: a. Know
all relevant information about his diagnosis, causes of the disease and
prognosis. b. Understand all risks, benefits and alternatives of the
recommended procedure and the percentage of success.
● If the patient refuses the treatment, therapist should clearly and
honestly explain to him the consequences and adverse effects of his
choice and document that.
● DO NOT force the patient to do something against his
will, i.e., the patient has the right to refuse treatment even
if it is beneficial to him, EXCEPT in case of emergency
● Therapists should use drawings, anatomical charts, or
models to clearly describe where, how and why the
patient will be touched.
● Confidentiality” and “Informed consent” are derived
from the principle of autonomy.
Informed consent
● It is an official legal document states that the patient has
been informed about his diagnosis, proposed treatment,
goals of treatment, potential risks or harms and
alternatives, and he understands and agrees to the
proposed treatment program.
 Requirements of informed consent:
● Information: giving the patient all relevant and necessary information
so he/she can make his/her decision.
● Willingness: ✓ It means that the patient should be free to make
his/her decision and take the decided action. ✓ Deception to guide
his/her decision is not as well accepted [It is intentionally misleading
a person to intentionally guide his decision, by lying, withholding
important information, exaggerating, or understating information.
● Competence: ✓ It means that the patient is competent to
understand and make health-care decisions. ✓ When the
patient is minor, unconscious adult, or unable to make
free decision, consent should be given by a family
member, or by an authorized legal guardian. ✓ In case of
serious emergency and absence of a family members or
legal guardian, the physician should do the action that
give the best benefit to the patient. (Paternalism)
Against autonomy
● A. Paternalism: it is overriding the patient’s autonomy by the medical
staff and NOT giving him the chance to decide for himself. i. When
the patient is NOT autonomous (i.e., mentally incompetent)
paternalism is a must.
● B. Treating patient without consent.
● c. Treating patient without giving him all relevant or necessary
information
● D. Deception OR Telling patient “white lies”.
● i. If you tell the patient white lies, you would affect the
doctor/patient relationship, lose patient’s trust and act
against the principle of autonomy. ii. Sometimes, it is
necessary to tell white lies.
● E. Withholding information from patient when he has
expressed the choice to receive it.
2. Beneficence
● Doing what is best or right for the patient
● It is a moral obligation of the healthcare professionals to act in the
best interest of their patients, provide benefits to their patients, and
show kindness and compassion.
● Our actions must aim to benefit patients’ health, welfare, comfort and
to improve their quality of life. Benefit should be defined by the
patients themselves, not what we think is good for them.
 ● Requirements of beneficence:
a. Knowledge of the beliefs, culture, values, and preferences
of the patient. What we think is good for our patient might be
harmful or unaccepted for him. b. Develop and maintain
knowledge and skills by continuous training. c. Consider
individual circumstances of all patients, i.e., your actions are
not suitable for all patients.
Paternalism is a form of beneficence
● It occurs when medical staff member believes that he knows what is better
for the patient and takes decisions for him
● Medical paternalism may include; i. Holding medical information of the
patient that prevents him from making correct decision.
● Medical paternalism is accepted in some cases when the patient is mentally
incompetent due to age, low IQ, or low cognitive and/or educational
abilities.
● Paternalism creates a conflict between “autonomy” and “beneficence” as
which of them is the most important one.
● Against beneficence
a. Refusing to provide treatment.
b. Refusing to help an accident victim.
c. Refusing to help a prisoner or a suspect of a
crime.
3. Non maleficence:
● To avoid intentionally causing harm to patients.
● The principle of not harming patients is more important
than helping them.
● One phrase can explain this principle, "To first DO NO
harm" OR “Above all DO NO harm” .
● Healthcare professionals must not harm a patient through
carelessness, malice, vengeance, or dislike.
● This principle is balanced with beneficence if the benefit
of treatment or procedure outweighs their harms or risks.
Sometimes when the treatment is very risky, the benefit
must be great, or the risk of not performing the procedure
must be great.
Examples of maleficence:
a. inflict harm on people.
b. prescribe medications known to be harmful.
c. painful exercise without need for that.
d. Using high intensity currents that cause the patient
discomfort
● Double effect: i. When the intervention done create some
benefit and some harm at the same time, it is known as
“double effect” , e.g., ✓Using morphine in dying patients,
strongly relieves pain and suffering, but also fastens
patient’s death as it suppresses respiratory system.
✓Using some vaccines may cause the infection it is
supposed to prevent. ✓Chemotherapy of cancer patients
may cause pain, fatigue and hair falling
4. Justice:
● It is the obligation that similarly situated persons have
fair distribution of available resources (benefits), burdens,
risks, and responsibilities among them, i.e., a. It means
that all patients have the right to receive the best care that
can be offered according to available resources.
● Justice is concerned with how patients are treated when
their interests conflict.
● Justice includes; a. Fairness, i.e., treating people fairly. b.
Equality, i.e., not favoring some patients over others. c.
Acting in a non discriminatory attitude. d. Respect
patients’ right. e. Respecting the law
1. Compensatory justice: It concerns compensation for
wrongs that have been done.
2. Procedural justice: It involves how the laws are
procedurally applied, i.e., Physical therapists must know
and follow the laws and rules of the country, as well as the
policy of the organization or institution.
3. Distributive justice: It means to share and allocate the
rare resources (e.g., beds, health services, equipment,
professionals’ time, etc.) in the society (or clinic) in a fair
manner.
Against justice:
a. Favoring one patient over another.
b. Senior and experienced doctor treats private
patients only
There are other ethical principles:
These include:
• Promise keeping.
• Truthfulness.
• Privacy.
• Confidentiality (DO NOT share information)
References

Chapter 1 in “Physical
Therapy Ethics”; 2nd edition,
by Donald L. Gabard and
Mark W. Martin
Thanks
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