That's the Spirit

By: Hannah Tobler, Alli Horning, Jordan Thielbar, Liane Siefker, Cara Schildmeyer, and Michael Russello
Summary of Case

• Physical therapist is working at a school one day a week with kids on IEPs. She has limited time
and can only dedicate one morning a week to the school. 
• The case load is three students however one student is supposed to be seen in two 30-minute
session. 
• The PT cannot come back for a second session with the student. She brings this up to the case
worker and her solution is to see the student at the beginning of her time and end that way they get
two sessions in. The PT does not think this will work for the patient even though it technically
satisfies the IEP. 
• She has brought this up to the case worker who has said it will be fine as well as read literature on
the subject that is inconclusive however the PT is still not comfortable with this decision. 
Theorists

• Kant 
• This would apply if the PT decided to continue to advise the caseworker that one of the students needs 2
30-min sessions per week without worrying about consequences she (the PT) may encounter as a result.
• Contractualism (John Locke) 
• This could be applied because she has a contractual obligation to the patient to provide the best therapy
possible as this view looks at the benefit of the individual instead of the group. In order to fulfill this
theory she should ensure the patient is provided two session of 30 minutes and if she believes it won't be
successful if she does them on one day then she should see to it that they are provided on separate days.  
• Mill's Utilitarianism
• This would apply if she decided to continue providing therapy even if she must give 2 30-min sessions
in one day. The most patients would be benefiting from her continuing to go even if one student wasn't
able to receive the full benefit of therapy. As this looks at the benefit of the group over the individual. 
Application to PT Code of Ethics 

•  3A. Physical therapists shall demonstrate independent and objective professional judgment in the patient’s or
client’s best interest in all practice settings.
•  3B. Physical therapists shall demonstrate professional judgment informed by professional standards, evidence
(including current literature and established best practice), practitioner experience, and patient and client
values.
• 3C. Physical therapists shall make judgments within their scope of practice and level of expertise and shall
communicate with, collaborate with, or refer to peers or other health care professionals when necessary.
• 7A. Physical therapists shall promote practice environments that support autonomous and accountable
professional judgments.
• 7F. Physical therapists shall refrain from employment arrangements, or other arrangements, that prevent
physical therapists from fulfilling professional obligations to patients and clients
• 8C. Physical therapists shall be responsible stewards of health care resources and shall avoid overutilization or
under- utilization of physical therapist services.
Problem Solving: RIPS Model
1. Evaluate all facts
2. Decide which ethical principles apply (already covered)
3. Decide Realm
• Realm is about obligation to do what is best for the patient's improvement (Individual)
4. Decide Process
• PT must decide between obeying their personal morals or submitting to their employer's wishes (moral sensitivity and judgement)
5. Decide level of Situation
• At the level of Dilemma/Distress, and possibly Temptation since the PT already tried to talk to their employer
6. Decide if true ethical dilemma-what ethical principle involved
• Beneficence, justice, autonomy
7. Clarify professional duty
• Code of Ethics Principles 3, 7, and 8 (see previous slide)
8. Describe general nature of outcome desired
• Outcome most beneficial to patient is desired
9. Describe the practical features
• Effectiveness and efficiency of actions, the risk, Code of Ethics
Conclusion

• The PT believes that doubling up on sessions for the student would

be a mistake, therefore she should only treat the student 1x a day
• The PT should continue to advocate for another PT to be brought
into the school so the student can receive 2-30 min sessions a week
• If the caseworker does not listen to the PT, then the PT could
contact the caseworker's superior in order to achieve the best
outcome for the student.