Ethics in Physical Therapy One of the most rapidly growing occupations in the United States today is Physical Therapy. The United States Department of Labor has projected 23, 000 unfilled physical therapist positions in the year 2000 and a lack of qualified physical therapists to fill them (web). While Physical Therapy grows rapidly, questions of ethics in this field have also grown in large quantities. Physical therapy is the treatment of disease through physical means, including light, heat, sound waves, electricity, magnetic fields, and exercise (web). This means that therapists use many different forms to treat people, and treating people can be a large challenge because of all the different possibilities that could occur with the different treatments.

Physical Therapy is a very rewarding and lucrative profession if the problems that come along with the job are dealt with in a capable manner. The main problem with Physical Therapy is the problem of the ethics of the profession. There are many ethical conflicts such as how to charge based on your services, and what types of services to give to each individual patient. To guide physical therapists in their decision making the American Physical Therapy Association came up with a code of ethics for it's members to set their standards to work by. Their members are required to work by this code and are also required to maintain ethical practices. The first principle in their code is to respect the rights and dignity of all individuals.

This includes all patients, employees, and co-workers. The second principle is to comply with all of the laws and regulations governing the practice of physical therapy. Physical therapists learn these laws in school before becoming a therapist. The third principle is that they must accept responsibility for their actions and exercise sound judgment. Every therapist must own up to their mistakes, and take responsibility for their patients. The fourth principle is that they must maintain and promote high standards for physical therapy practice, education, and research.

No therapist should ever compromise his or her beliefs for any reason. The fifth principle is that they must seek remuneration for their services that is deserved and reasonable. This means that they should be paid for the work that they do, but that the pay should be a reasonable amount. The sixth principle is that they must provide accurate information to the consumer about the profession and about those services they provide.

This includes a thorough explanation of what they will be doing while servicing a patient. The seventh principle is that they must accept the responsibility to protect the public and the profession from unethical, incompetent, or illegal acts. This means that if they are aware of any unethical acts, they are obligated to report them. The eight and final principle is that they must participate in efforts to address the health needs of the public (Code of Ethics). These principles have been addresses, but there are still many problems in the system.

To assess some of the problems that therapists feel are important, many surveys are conducted. One survey by the United Kingdom National Health Service wanted to compare ethical contexts and themes, so they sent a structured questionnaire to many different physical therapy groups around the country. The therapists filled out the questionnaires and the results found that the most common ethical problems among therapists in the United Kingdom were dangerous behaviors in patients and unprofessional staff behavior. Their second biggest concern was resource limitations and treatment effectiveness.

These findings suggested that educators of future physical therapists need to make students aware of work settings and the interdisciplinary nature of employment as well as principles held by individual therapists (Barnett). The American Physical Therapy Association also conducted a study to identify current ethical issues and also issues that may be faced in the future by therapists. They used a technique called the Delphi technique, where a panel of experts was selected and the experts responded to questionnaires stating their concerns with ethics. The experts narrowed their concerns down to three categories: patient rights and welfare, professional issues, and business factors.

The experts chose six patient rights and welfare issues, five professional issues, and five relating to business factors to be the most important. The first issues addressed, the patients' rights and welfare issues, were the primary concern of the panel of experts. The issues at hand focused on interactions, confidentiality, sexuality, and consensual issues between doctors and patients. Any interaction between a doctor and patient should be understood and clear. Sexual activities between doctor and patient should be prohibited, and all interactions should be ensured as confidential. The second issues faced were professional ones.

These issues dealt primarily with policies and relations between health professionals. Some issues listed in this category were maintaining clinical competence, supervising personnel, taking care of the environment, and reporting any misconduct of others. Therapists should be competent in their work, their personnel should be supervised at all times, their environment should be sanitary and clean, and they should feel obligated to report and wrong doing of their peers. The third and final category discussed was business and economics.

The issues outlined in this category included appropriate fees, advertising, endorsement of equipment, exploitive business relationships, and billing fraud. Physical therapists are expected to charge appropriate fees for their services, they are expected to advertise fairly and truthfully, they should endorse equipment without exploiting themselves or others, and they should bill fairly and justly for their services (Triezenberg and Purtilo). A few of the future ethical problems they outlined are the over-utilization of services, the protection of the patient's rights, the justification of the appropriate fees for the services rendered, the ethical guidelines for the use of human subjects in research, and responsibilities of physical therapists. The over-utilization of services would be using the service too much. The protection of the patient's rights includes privacy issues.

The justification of the appropriate fees for the services rendered would be proper billing. The ethical guidelines for the use of human subjects in research includes making sure the human subjects are not harmed in any way, and are treated fairly. The responsibilities of physical therapists include their duty to respond to environmental issues, as well as social issues (Triezenberg and Purtilo). Since one of the main problems addressed by the therapists surveyed was the behavior among their co-workers and patients, some of these behaviors should be examined and explained. The elderly are one of the largest groups of people that partake of the care of Physical Therapists. Sometimes, though, their care is not quality service and they can often be cheated out of money.

One study on Physical and Occupational Therapy in Nursing found that even though patients received the therapy needed and their wellness improved because of it, 13% of the patients were not properly billed, and 4% were not documented properly in the patient's medical records. Some reasons for being billed improperly were that the people providing the services were not qualified to do so, therefore they were charging for a job that they were not authorized to do. Another report, 'Physical and Occupational Therapy in Nursing Homes: Cost of Improper Billings to Medicare,' estimated amounts of money that were billed or documented improperly during a one year period ending June 30, 1998. They estimated that $1 billion for improperly billed physical and occupational therapy and $331 million for improperly documented physical and occupational therapy was paid by Medicare to these workers (How to Fix Therapy Services). The government has taken many steps to fix these problems. The main government agency for these problems, Medicare, has done many evaluations and reviews to ensure things are being done right, especially in nursing homes.

Medicare is now requiring more documentation regarding health care and is also making sure that all employees are aware of the guidelines that they set. Medicare is also making sure that therapists and assistants clearly know their job role, and do not do work that they are not authorized to do (How to Fix Therapy Services). Any unauthorized work would be done a physical therapist's assistant. The American Physical Therapists Association's Guide to Physical Therapists Practice outlines the role of an assistant to a physical therapist, and states what they can and cannot do. First of all, any kind of therapy should always be "under the direction or supervision of a physical therapist." Therefore, if any sort of therapy is done by the assistant and is not under supervision of the therapist, then nothing in the prognosis should be represented as actual physical therapy (Guide to Physical Therapist Practice).

These sorts of practices are also being investigated and fixed by Medicare services. These are just some ethical problems that Physical Therapists deal with every day. Therapists can help prevent any problems by conducting their practices following the guidelines set by them, and by avoiding any problems that have been foreshadowed for the future. There will always be ethical problems in businesses, but by working together therapists can help improve conditions and eventually fix them.

Works CitedBarnitt, Rosemary "Ethical dilemmas in Occupational Therapy and Physical Therapy: A Survey of Practitioners in the UK National Health Service." Journal of Medical Ethics. V. 24 N. 3 (June 1998): p 193.

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