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INTRODUCTION

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Physical therapists shall be accountable for making sound professional judgments.

Principle 3, APTA Code of Ethics

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CASE 1.1 Steroids in School

Shirlaine is a physical therapist working for a public school system.1 Her duties consist primarily in screening high school athletes during the preseason and then treating injuries caused during practice or games. Currently she is treating Donald, the school's 11th grade star wrestler and champion weight-lifter, for a minor tear in his tendon at the biceps brachii muscle insertion. She notices excessive muscle hypertrophy as the tear heals. Because she knows that anabolic steroids are a common cause of such problems, and because she had previously suspected that Donald was using illegal drugs, she asks him whether he is using any steroids. At first he denies it, but eventually he confesses to using unprescribed methandrostenolone.

Shirlaine immediately urges him to stop using the drug and informs him of its potentially life-threatening side-effects, including liver disease and cancer. He replies that he cares only about winning the state championship and begs her to keep the matter secret. He also says his competitors are using steroids, and it is unfair to deny him the opportunity to compete at their level. Moreover, he is confident he will not be caught. At one point he uses a threatening tone that makes Shirlaine feel her job might be in jeopardy if she divulges the information. In addition, Shirlaine knows the coach is an aggressive competitor who is lackadaisical about drug use.

Summarized from Bruckner J. Physical therapists as double agents: Ethical dilemmas of divided loyalties. Phys Ther. 1987;67(3):383–387 with permission of the American Physical Therapy Association.

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Shirlaine faces an ethical dilemma, perhaps several of them. Ethical dilemmas are situations in which moral reasons come into conflict, and it is not immediately obvious what should be done. In this chapter, we identify the steps in resolving ethical dilemmas. Before doing so, we define physical therapy ethics and discuss why it should be studied. We also discuss how ethics and professionalism are connected and the importance of professional codes of ethics. Throughout, we understand professionalism as an umbrella value that encompasses many more specific values to which professionals should commit themselves.

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WHAT IS PHYSICAL THERAPY ETHICS?

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The word “ethics” is ambiguous and hence so is “physical therapy ethics.” We distinguish several primary senses, both normative and descriptive ones.

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Normative Versus Descriptive Ethics

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In the main senses used in this book, ethics refers to normative ethics, which aims at identifying, understanding, and applying justified moral values. Moral values include what is obligatory (right), permissible (all right), good, or otherwise morally valuable. The goal is to understand and apply justified moral values to personal decisions and character, public policies and laws, and organizational procedures and structures.

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In one normative sense, ethics names an area of study, ...

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