Ethics is the heart of professionalism. Just as much as technical skill, moral commitment enables physical therapists to provide quality services for patients, work effectively with colleagues, and maintain the trust of the public. At a more personal level, moral commitment motivates, guides, and gives meaning to work.
Physical therapists' special expertise and distinctive roles working closely and at length with patients allow them to bring a unique perspective to health-care ethics. Therapists also contribute to health-care ethics by participating in professional societies, serving on hospital ethics committees, revising health-care policies, and engaging in daily dialogue with other professionals. Hence, it is no surprise that the study of professional ethics now plays a prominent role in the curriculum and in professional settings.
Like health care itself, the exploration of physical therapy ethics is an interdisciplinary effort. This book integrates the practical interests of physical therapists with philosophical ethics—a combination of disciplines that has similarly proved fruitful in the development of other branches of health-care ethics. Practical interests are engaged in many ways: by identifying and organizing a wide array of practitioners' concerns and debates within the profession, providing numerous case studies of ethical dilemmas and responsible conduct, discussing relevant laws, and frequently referring to the American Physical Therapy Association's Code of Ethics and accompanying Guide for Professional Conduct. Philosophical approaches include attention to major ethical theories but primarily center around distinctions from and approaches to what philosophers call applied or practical ethics.
Our aim throughout this book is to provide tools for students and practitioners of physical therapy as they confront ethical dilemmas and moral controversy. Equally, our aim is to stimulate reflection on the moral significance of therapists' work, which remains a neglected area in the study of health care. Sometimes these aims are best served by withholding our views as authors, to provide balanced presentations of differing perspectives. Other times we present our position on issues, hoping thereby to provoke more discussion than would a mere summary of others' views.
Most of the chapters employ a dual organizing principle, as indicated by the chapter titles: a key value combined with a cluster of related topics in which that value plays a major role. For example, the key value in Chapter 8 is honesty, and the topics concern conflicts of interest. Usually the key value refers simultaneously to a responsibility (an obligation) and a virtue (a good feature of character). Thus, honesty is owed as a duty to patients, and it is also a virtue of caregivers. Of course, no single value operates exclusively in any one domain of a profession, but we have found this approach contributes to thematic unity and pedagogical effectiveness.
Finally, we note that the Guide to Physical Therapist Practice makes an important distinction between “patient” and “client.” Physical therapist practice addresses the needs of both patients and clients through a continuum of service across all delivery settings—in critical and intensive care units, outpatient clinics, long-term care facilities, school systems, and the workplace—by identifying health improvement opportunities, providing interventions for existing and emerging problems, preventing or reducing the risk of additional complications, and promoting wellness and fitness to enhance human performance as it relates to movement and health. Patients are recipients of physical therapist examination, evaluation, diagnosis, prognosis, and intervention and have a disease, disorder, condition, impairment, functional limitation, or disability; clients engage the services of a physical therapist and can benefit from the physical therapist's consultation, interventions, professional advice, prevention services, or services promoting health, wellness, and fitness. For stylistic reasons, however, we have elected to most often use “patient,” often the more vulnerable of the two categories, even though “patient/client” is in some cases most accurate.