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Physical therapists shall respect the inherent dignity and rights of all individuals.

Principle 1, APTA Code of Ethics

CASE 3.1 Unwanted Therapy

Martha Sullivan is an 83-year-old widow who was admitted to a skilled nursing facility because of a broken hip caused by a fall. The hip has mended well, and now the physical therapist is working on balance skills. This was not the first fall for Mrs. Sullivan, and she has been having increasing difficulty in caring for herself since her husband's death. Her children are worried that she might be injured in her home with no one available to help her. Both her children live out of state and, since her husband's death, Mrs. Sullivan has lost interest in maintaining the friendships she had previously found rewarding.

Anna is Mrs. Sullivan's physical therapist, and the two have developed an excellent rapport. Mrs. Sullivan has been the ideal patient, doing all her home exercises. But Anna was caught by surprise when she went to Mrs. Sullivan's room 15 minutes early to find her with her face in a pillow to hush the sounds of her crying. Anna put her arm around her patient and asked why she was so upset. Mrs. Sullivan responded that she found therapy scary because she was afraid she would fall again, and she was sure she would not live through another convalescent period. All she really wanted to do was to use a walker in her room and use a wheelchair when she went outside. Anna asked her why she had not mentioned this before. Mrs. Sullivan explained that she was afraid that if she refused anything, the nursing facility would put her out or even have her declared incompetent. If they had declared her incompetent, she could be sent to a far worse location and would lose control of what little money she had left. She also stated that neither of her children wanted her with them and that she had no place else to go.

Anna feels sure she can coax Mrs. Sullivan into continuing therapy, but she also feels unsure about whether she should attempt to change Mrs. Sullivan's mind or merely stop by for social calls until Mrs. Sullivan requests more therapy.

The principle of autonomy asserts there is a responsibility to respect the autonomy (self-determination) of each person. No principle is more important to health-care ethics or indeed to all professional ethics. The principle is more complex than first appears, as the case of Martha Sullivan suggests. This chapter begins by noting how respect for autonomy has largely replaced medical paternalism. We then focus on three specific professional duties entailed by the principle of autonomy, each of which concerns the patient's control over personal information: informed consent, truth telling (veracity), and confidentiality (privacy). The goal is to develop a nuanced understanding of these duties, including their meaning, moral foundations, and the moral dilemmas that ...

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