Module 4 - Ethical Practice Flashcards
What are 4 clues that may signal you are heading towards an ethical issue
- Wondering if its legal
- Trying to keep it secret
- Experiencing a gut feeling that its wrong
- Making rationalizations (eg. “This wont hurt anyone)
Ethical issues can be characterized by what 3 things
1.Ethical uncertainty
2. Ethical distress
3. Ethical dilemma
Ethical Uncertainty Example
HCP uncertain about accepting a gift from a client or attending clients funeral
Ethical Distress Example
HCP may feel that right course of action is to provide more therapy to an individual who has the potential to go home, but the team may decide to discharge the client to a long term care home
Ethical Dilemma
HCP must choose between two equally compelling situations (sole charge practitioner in an underserviced area must decide which populations/clients they would offer service to)
What are 4 ways to solve ethical issues
- Ethical Philosophy
- Four principles approach
- Narrative ethics
- Professional code of ethics: Principles and values
List the 4 ethical principles approach
- Beneficence: Obligation to provide benefits and to balance benefits against risks
- Non-maleficence: Obligation to avoid causing harm
- Respect for autonomy: Obligation to respect the client/family/community’s autonomy to make decisions about their lives
- Justice: Obligations of fairness in the distribution of benefits and risks (for the good of the whole)
Narrative Ethics
Humans interpret and assign meaning to their live experiences
T or F: We have a duty to report suspected abuse if there is reasonable grounds (whether physical or sexual)
T
What are the 5 codes of ethics for PT
What are the 6 steps to ethical decision making
Health services means a service to
- To protect, promote and/or maintain their health
- To prevent illness
- To diagnose, treat or rehabilitate
- To take care of health needs of the ill, disabled, injured, or dying
Health services are governed by who in Ontario?
Regulated Health Care Professions Act
Patients
Direct recipients of health services provided by regulated member and does not include their parents, guardians, or substitute decision maker
How long are patients yours?
Up to 1 year after their last treatment relationship ending
T or F: You can treat family members and spouses
F
What are the 4 guidelines for professional conduct
1) provide assessment and treatment
2) take into account patients vulnerability
3 be cognizant of our own cultural perspective
4) Establish a therapeutic relationship
What is a therapeutic relationship
Relationship between a regulated health professional and patient
What are the 4 key components to the therapeutic relationship
What are the key take aways for building therapeutic relationships
1) need patient consent
2) patients uncomfortable when close in proximity
3) patients can mistaken closeness as sexual assault
4) approach patients with sensitivity
5)persons tolerances for physical closeness are difference
6)never should assume, always explain what an assessment will entail in regards to physical touch so they understand
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1) persons tolerances for physical closeness are difference
2) never should assume, always explain what an assessment will entail in regards to physical touch so they understand
What are 9 characteristics of sensitive practice
1) be mindful of others interpretation with physical touch
2) culture and past experiences can affect physical touch
3) explain why physical touch will occur so they understand
4) reassure and use regular check ins
5) patient can withdraw consent at any time
6) speak clearly with appropriate language
7) can have someone else there or give them privacy
8) let patients know about objective/subjective assessments and have opportunity for them to ask questions
9) revisit consent throughout process
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Professional Boundary
professional boundary separates personal and professional relationship with client by recognizing the power imbalance, client vulnerability and responsibilities of HCP in the professional relationships
Dual Relationships
Occur when HCP enters in both professional and personal relationship with an individual (avoid these if possible but not always because it can cross boundaries-> remote communities with single providers = important to put up safeguards such as telehealth or discussing relationship with client)
Boundary Crossing
A benign temporary situation where interactions depart from established professional relationships and it becomes unbalanced in favour of the provider usually
Boundary Violation
Occurs when nature of therapeutic relationship moves from professional to personal and there is a disregard for professional boundaries (usually in favour of HCP)
Types of reflection questions to evaluate boundary crossings/violations
What are 4 impacts of boundary crossings and violations
How to establish clear boundaries 1/2
How to establish clear boundaries 2/2
To establish boundaries for PT apply the 4A approach
What to do if a boundary crossing happens
What to do if a patient crosses a boundary 1/2
What to do if a patient crosses a boundary 2/2
T or F: It is important to not enter an intimate relationship with their patient or their relatives for at least 1 year after they have stopped being a patient
T
HCPs must not enter into intimate relationships with a patient unless
Sexual Misconduct
Characterized by behavior or remarks of sexual nature to patient that is unwanted and has impact on their well being
Examples of sexual misconduct
Other examples of professional misconduct
Sexual Abuse
Threatened, attempted or actual conduct of HCP towards a patient that is of sexual nature
Examples of sexual abuse
T or F: there is not a zero tolerance policy for sexual abuse
F, there is a zero tolerance policy and this counts for spouses also (even with consent)
Mandatory Reporting (Duty to report
Circumstances where you are required to report misconduct to regulatory college
T or F: You must self-report any unprofessional behavior to all regulatory colleges you are involved with (and when you move provinces)
T
What other scenarios require mandatory reporting of misconducts
- Reporting other regulated HCPS (need reasonable grounds)
- Employers can also report if have reasonable grounds on their HCP that works for them
**Employer must report even if not regulated HCP or HCP has resigned or is fired
What do you have a duty to report
What happens if you fail to report misconduct
What is reasonable grounds
A sufficient amount of evidence that is credible and concrete and obtained from a reliable source
If you are unsure about whether or not you have reasonable grounds you should
Call your regulatory college and they will assist you in making that decision
When to report client/family conditions (varies by college)
If unsure about anything what should you do
Call the regulatory college
T or F: You are not required to continuously review your colleges code of ethics
F, you are required
Physiotherapy college specific reporting (where, when, what)
T or F: there is funds for victims of sexual abuse for each college to finance patients who have been sexually abused
T
Code of Ethics definition for physiotherapy
What are the 5 ethical values for physiotherapists (COE for PT)
What are the 6 steps of ethical decision making for PT’s (COE for PT)
What are 10 misconceptions of crossing boundaries
- Its always about sex
- Boundary crossing just happens
- It was destiny
- Its ok as long as there is no power imbalance
- Its ok if the personal relationship comes first and treatment second
- Sexual abusers are predators
- no one is going to tell
- They cant prove a thing
- Concealing your professional status removes the power imbalance
- Being compassionate justifies crossing boundaries
T or F: to be ethical requires us to use evidence-based practice
T
What are the 6 steps to ethical decision making
- Recognize that there is an ethical issue—i.e. something is making you uncomfortable. (Do you all feel (literally in your body) there is an ethical issue here?)
- Identify the problem and who is involved—What is making you uncomfortable? (Is it ethical uncertainty, distress or a dilemma?) Who else is involved?
- Consider the relevant facts, laws, principles and values—What laws or standards might apply? What REACH value or ethical principle is involved?
- Establish and analyze potential options—Weigh possibilities and outcomes. Use your moral imagination.
- Choose a course of action — What are the potential barriers to action? What information should be recorded?
- How could you Evaluate the outcome to determine if further action is needed? What would you do to prevent a similar occurrence in the future?
