APTA Guide for Professional Conduct
Purpose
This Guide for Professional Conduct (Guide) is
intended to serve physical therapists in interpreting the Code of
Ethics (Code) of the American Physical Therapy Association
(Association), in matters of professional conduct. The Guide provides
guidelines by which physical therapists may determine the propriety of
their conduct. It is also intended to guide the professional development
of physical therapist students. The Code and the Guide apply to all
physical therapists. These guidelines are subject to change as the
dynamics of the profession change and as new patterns of health care
delivery are developed and accepted by the professional community and
the public. This Guide is subject to monitoring and timely revision by
the Ethics and Judicial Committee of the Association.
Interpreting Ethical Principles
The interpretations expressed in this Guide reflect
the opinions, decisions, and advice of the Ethics and Judicial
Committee. These interpretations are intended to assist a physical
therapist in applying general ethical principles to specific situations.
They should not be considered inclusive of all situations that could
evolve.
PRINCIPLE 1
A physical therapist shall respect the rights and dignity of all
individuals and shall provide compassionate care.
1.1 Attitudes of a Physical
Therapist
A. A physical therapist shall recognize, respect, and
respond to individual and cultural differences with compassion and
sensitivity.
B. A physical therapist shall be guided at all times
by concern for the physical, psychological, and socioeconomic welfare of
patients/clients.
C. A physical therapist shall not harass, abuse, or
discriminate against others.
PRINCIPLE 2
A physical therapist shall act in a trustworthy manner towards
patients/clients, and in all other aspects of physical therapy
practice.
2.1 Patient/Physical Therapist Relationship
A. A physical therapist shall place the patient/client's interest(s)
above those of the physical therapist. Working in the patient/client's
best interest requires knowledge of the patient/client's needs from the
patient/client's perspective. Patients/clients often come to the
physical therapist in a vulnerable state and normally will rely on the
physical therapist's advice, which they perceive to be based on superior
knowledge, skill, and experience. The trustworthy physical therapist
acts to ameliorate the patient's/client's vulnerability, not to exploit
it.
B. A physical therapist shall not exploit any aspect of the physical
therapist/patient relationship.
C. A physical therapist shall not engage in any sexual relationship
or activity, whether consensual or nonconsensual, with any patient while
a physical therapist/patient relationship exists. Termination of the
physical therapist/patient relationship does not eliminate the
possibility that a sexual or intimate relationship may exploit the
vulnerability of the former patient/client.
D. A physical therapist shall encourage an open and collaborative
dialogue with the patient/client.
E. In the event the physical therapist or patient
terminates the physical therapist/patient relationship while the patient
continues to need physical therapy services, the physical therapist
should take steps to transfer the care of the patient to another
provider.
2.2 Truthfulness
A physical therapist has an obligation to provide accurate and
truthful information. A physical therapist shall not make statements
that he/she knows or should know are false, deceptive, fraudulent, or
misleading. See Section 8.2.C and D.
2.3 Confidential Information
A. Information relating to the physical
therapist/patient relationship is confidential and may not be
communicated to a third party not involved in that patient's care
without the prior consent of the patient, subject to applicable law.
B. Information derived from peer review shall be held
confidential by the reviewer unless the physical therapist who was
reviewed consents to the release of the information.
C. A physical therapist may disclose information to
appropriate authorities when it is necessary to protect the welfare of
an individual or the community or when required by law. Such disclosure
shall be in accordance with applicable law.
2.4 Patient Autonomy and Consent
A. A physical therapist shall respect the patient's/client's right to
make decisions regarding the recommended plan of care, including
consent, modification, or refusal.
B. A physical therapist shall communicate to the patient/client the
findings of his/her examination, evaluation, diagnosis, and
prognosis.
C. A physical therapist shall collaborate with the patient/client to
establish the goals of treatment and the plan of care.
D. A physical therapist shall use sound professional judgment in
informing the patient/client of any substantial risks of the recommended
examination and intervention.
E. A physical therapist shall not restrict patients' freedom to
select their provider of physical therapy.
PRINCIPLE 3
A physical therapist shall comply with laws and regulations
governing physical therapy and shall strive to effect changes that
benefit patients/clients.
3.1 Professional Practice
A physical therapist shall comply with laws governing
the qualifications, functions, and duties of a physical therapist.
3.2 Just Laws and Regulations
A physical therapist shall advocate the adoption of
laws, regulations, and policies by providers, employers, third party
payers, legislatures, and regulatory agencies to provide and improve
access to necessary health care services for all individuals.
3.3 Unjust Laws and Regulations
A physical therapist shall endeavor to change unjust
laws, regulations, and policies that govern the practice of physical
therapy. See Section 10.2.
PRINCIPLE 4
A physical therapist shall exercise sound professional
judgment.
4.1 Professional Responsibility
A. A physical therapist shall make professional
judgments that are in the patient/client's best interests.
B. Regardless of practice setting, a physical
therapist has primary responsibility for the physical therapy care of a
patient and shall make independent judgments regarding that care
consistent with accepted professional standards. See Sections 2.4 and
6.1.
C. A physical therapist shall not provide physical
therapy services to a patient/client while his/her ability to do so
safely is impaired.
D. A physical therapist shall exercise sound
professional judgment based upon his/her knowledge, skill, education,
training, and experience.
E. Upon accepting a patient/client for physical
therapy services, a physical therapist shall be responsible for: the
examination, evaluation, and diagnosis of that individual; the prognosis
and intervention; re-examination and modification of the plan of care;
and the maintenance of adequate records, including progress reports. A
physical therapist shall establish the plan of care and shall provide
and/or supervise and direct the appropriate interventions. See Section
2.4.
F. If the diagnostic process reveals findings that
are outside the scope of the physical therapist's knowledge, experience,
or expertise, the physical therapist shall so inform the patient/client
and refer to an appropriate practitioner.
G. When the patient has been referred from another
practitioner, the physical therapist shall communicate pertinent
findings and/or information to the referring practitioner.
H. A physical therapist shall determine when a
patient/client will no longer benefit from physical therapy services.
See Section 7.1.D.
4.2 Direction and Supervision
A. The supervising physical therapist has primary
responsibility for the physical therapy care rendered to a
patient/client.
B. A physical therapist shall not delegate to a less
qualified person any activity that requires the professional skill,
knowledge, and judgment of the physical therapist.
4.3 Practice Arrangements
A. Participation in a business, partnership,
corporation, or other entity does not exempt physical therapists,
whether employers, partners, or stockholders, either individually or
collectively, from the obligation to promote, maintain and comply with
the ethical principles of the Association.
B. A physical therapist shall advise his/her employer(s) of any employer
practice that causes a physical therapist to be in conflict with the
ethical principles of the Association. A physical therapist shall seek
to eliminate aspects of his/her employment that are in conflict with the
ethical principles of the Association.
4.4 Gifts and Other
Consideration(s)
A. A physical therapist shall not invite, accept, or offer gifts,
monetary incentives, or other considerations that affect or give an
appearance of affecting his/her professional judgment.
B. A physical therapist shall not offer or accept kickbacks in exchange
for patient referrals. See Sections 7.1.F and G and 9.1.D.
PRINCIPLE 5
A physical therapist shall achieve and maintain professional
competence.
5.1 Scope of Competence
A physical therapist shall practice within the scope of his/her
competence and commensurate with his/her level of education, training
and experience.
5.2 Self-assessment
A physical therapist has a lifelong professional responsibility for
maintaining competence through on-going self-assessment, education, and
enhancement of knowledge and skills.
5.3 Professional Development
A physical therapist shall participate in educational activities that
enhance his/her basic knowledge and skills. See Section 6.1.
PRINCIPLE 6
A physical therapist shall maintain and promote high standards for
physical therapy practice, education and research.
6.1 Professional Standards
A physical therapist's practice shall be consistent
with accepted professional standards. A physical therapist shall
continuously engage in assessment activities to determine compliance
with these standards.
6.2 Practice
A. A physical therapist shall achieve and maintain
professional competence. See Section 5.
B. A physical therapist shall demonstrate his/her
commitment to quality improvement by engaging in peer and utilization
review and other self-assessment activities.
6.3 Professional Education
A. A physical therapist shall support high-quality
education in academic and clinical settings.
B. A physical therapist participating in the
educational process is responsible to the students, the academic
institutions, and the clinical settings for promoting ethical conduct. A
physical therapist shall model ethical behavior and provide the student
with information about the Code of Ethics, opportunities to discuss
ethical conflicts, and procedures for reporting unresolved ethical
conflicts. See Section 9.
6.4 Continuing Education
A. A physical therapist providing continuing
education must be competent in the content area.
B. When a physical therapist provides continuing
education, he/she shall ensure that course content, objectives, faculty
credentials, and responsibilities of the instructional staff are
accurately stated in the promotional and instructional course
materials.
C. A physical therapist shall evaluate the efficacy
and effectiveness of information and techniques presented in continuing
education programs before integrating them into his or her practice.
6.5 Research
A. A physical therapist participating in research
shall abide by ethical standards governing protection of human subjects
and dissemination of results.
B. A physical therapist shall support research
activities that contribute knowledge for improved patient care.
C. A physical therapist shall report to appropriate authorities any
acts in the conduct or presentation of research that appear unethical or
illegal. See Section 9.
PRINCIPLE 7
A physical therapist shall seek only such remuneration as is
deserved and reasonable for physical therapy services.
7.1 Business and Employment Practices
A. A physical therapist's business/employment
practices shall be consistent with the ethical principles of the
Association.
B. A physical therapist shall never place her/his own
financial interest above the welfare of individuals under his/her
care.
C. A physical therapist shall recognize that
third-party payer contracts may limit, in one form or another, the
provision of physical therapy services. Third-party limitations do not
absolve the physical therapist from making sound professional judgments
that are in the patient's best interest. A physical therapist shall
avoid underutilization of physical therapy services.
D. When a physical therapist's judgment is that a
patient will receive negligible benefit from physical therapy services,
the physical therapist shall not provide or continue to provide such
services if the primary reason for doing so is to further the financial
self-interest of the physical therapist or his/her employer. A physical
therapist shall avoid overutilization of physical therapy services. See
Section 4.1.H.
E. Fees for physical therapy services should be
reasonable for the service performed, considering the setting in which
it is provided, practice costs in the geographic area, judgment of other
organizations, and other relevant factors.
F. A physical therapist shall not directly or
indirectly request, receive, or participate in the dividing,
transferring, assigning, or rebating of an unearned fee. See Sections
4.4.A and B.
G. A physical therapist shall not profit by means of a credit or
other valuable consideration, such as an unearned commission, discount,
or gratuity, in connection with the furnishing of physical therapy
services. See Sections 4.4.A and B.
H. Unless laws impose restrictions to the contrary,
physical therapists who provide physical therapy services within a
business entity may pool fees and monies received. Physical therapists
may divide or apportion these fees and monies in accordance with the
business agreement.
I. A physical therapist may enter into agreements
with organizations to provide physical therapy services if such
agreements do not violate the ethical principles of the Association or
applicable laws.
7.2 Endorsement of Products or Services
A. A physical therapist shall not exert influence on
individuals under his/her care or their families to use products or
services based on the direct or indirect financial interest of the
physical therapist in such products or services. Realizing that these
individuals will normally rely on the physical therapist's advice, their
best interest must always be maintained, as must their right of free
choice relating to the use of any product or service. Although it cannot
be considered unethical for physical therapists to own or have a
financial interest in the production, sale, or distribution of
products/services, they must act in accordance with law and make full
disclosure of their interest whenever individuals under their care use
such products/services.
B. A physical therapist may receive remuneration for
endorsement or advertisement of products or services to the public,
physical therapists, or other health professionals provided he/she
discloses any financial interest in the production, sale, or
distribution of said products or services.
C. When endorsing or advertising products or
services, a physical therapist shall use sound professional judgment and
shall not give the appearance of Association endorsement unless the
Association has formally endorsed the products or services.
7.3 Disclosure
A physical therapist shall disclose to the patient if the referring
practitioner derives compensation from the provision of physical
therapy.
PRINCIPLE 8
A physical therapist shall provide and make available accurate and
relevant information to patients/clients about their care and to the
public about physical therapy services.
8.1 Accurate and Relevant Information to the
Patient
A. A physical therapist shall provide the
patient/client accurate and relevant information about his/her condition
and plan of care. See Section 2.4.
B. Upon the request of the patient, the physical
therapist shall provide, or make available, the medical record to the
patient or a patient-designated third party.
C. A physical therapist shall inform patients of any
known financial limitations that may affect their care.
D. A physical therapist shall inform the patient
when, in his/her judgment, the patient will receive negligible benefit
from further care. See Section 7.1.C.
8.2 Accurate and Relevant Information to the
Public
A. A physical therapist shall inform the public about
the societal benefits of the profession and who is qualified to provide
physical therapy services.
B. Information given to the public shall emphasize
that individual problems cannot be treated without individualized
examination and plans/programs of care.
C. A physical therapist may advertise his/her
services to the public. See Section 2.2.
D. A physical therapist shall not use, or participate
in the use of, any form of communication containing a false,
plagiarized, fraudulent, deceptive, unfair, or sensational statement or
claim. See Section 2.2.
E. A physical therapist who places a paid
advertisement shall identify it as such unless it is apparent from the
context that it is a paid advertisement.
PRINCIPLE 9
A physical therapist shall protect the public and the profession
from unethical, incompetent, and illegal acts.
9.1 Consumer Protection
A. A physical therapist shall provide care that is
within the scope of practice as defined by the state practice act.
B. A physical therapist shall not engage in any conduct that is
unethical, incompetent or illegal.
C. A physical therapist shall report any conduct that appears to be
unethical, incompetent, or illegal.
D. A physical therapist may not participate in any arrangements in
which patients are exploited due to the referring sources' enhancing
their personal incomes as a result of referring for, prescribing, or
recommending physical therapy. See Sections 2.1.B, 4, and 7.
PRINCIPLE 10
A physical therapist shall endeavor to address the health needs of
society.
10.1 Pro Bono Service
A physical therapist shall render pro bono publico (reduced or no
fee) services to patients lacking the ability to pay for services, as
each physical therapist's practice permits.
10.2 Individual and Community Health
A. A physical therapist shall be aware of the patient's
health-related needs and act in a manner that facilitates meeting those
needs.
B. A physical therapist shall endeavor to support activities that
benefit the health status of the community. See Section 3.
PRINCIPLE 11
A physical therapist shall respect the rights, knowledge, and
skills of colleagues and other healthcare professionals.
11.1 Consultation
A physical therapist shall seek consultation whenever the welfare of
the patient will be safeguarded or advanced by consulting those who have
special skills, knowledge, and experience.
11.2 Patient/Provider Relationships
A physical therapist shall not undermine the
relationship(s) between his/her patient and other healthcare
professionals.
11.3 Disparagement
Physical therapists shall not disparage colleagues and other health
care professionals. See Section 9 and Section 2.4.A.
Issued by Ethics and Judicial Committee
American Physical Therapy Association
October 1981
Last Amended January 2004
[Last updated: 1/04 | Contact: ejc@apta.org]
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