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Physical therapists shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, research participants, other healthcare providers, employers, payers, and the public.

Principle 4, APTA Code of Ethics

CASE 12.1 Permissible to Lie?

Luis Alvarez, a physical therapist working in a rehabilitation clinic, has a female client who was injured in a domestic dispute. Luis was approaching the treatment area where his client was waiting in one of the private treatment areas when the client's irate spouse approached him and asked if his wife was in “there,” pointing to the treatment room. The man's demeanor suggested both anger and intoxication, and Luis feared the spouse might complete the battering that led to the admission of the client. Is it correct for Luis to lie, by saying his client has been discharged, thereby allowing himself time to call security and warn the proper authorities? Or should he pursue a different strategy because lying is undesirable, especially in one's role as a professional?

Sound moral judgment must often be exercised promptly, as in the situation faced by Luis Alvarez, with little time to consider an ideal solution. Regardless of its urgency, however, moral judgment is exercised against the background of moral understanding. Ethical theories are attempts to articulate sound moral understanding in a systematic way. They attempt to provide clear, consistent, and comprehensive accounts of morality that are compatible with one's most carefully considered convictions.

Ethical theories have several uses. They cannot, of course, remove moral complexity, and if anything they highlight the moral complexity of even familiar acts, such as lying.1 They do, however, help clarify and resolve ethical dilemmas by pinpointing and organizing moral reasons. Ethical theories also provide ethical frameworks that can be used to justify general principles in bioethics, such as beneficence and respect for autonomy, as well as more focused rules such as “Do not lie.” Ethical theories also can be used for justifying or for critiquing entries in professional codes of ethics as well as general policies and practices in health care and organizations. In this way, ethical theories provide ways of grounding physical therapy ethics in deeper and broader moral perspectives.

Philosophers have developed several influential types of theories.2 In this chapter we introduce six, each of which has many defenders and each of which has greatly influenced thinking about health-care ethics: rights ethics, duty ethics, utilitarianism, virtue ethics, religious ethics, and pragmatism. There are additional theories that we have touched on earlier, for example care ethics in Chapter 2 and feminist theories discussed in Chapter 5 but the six theories discussed here represent a good sampling of major approaches in health-care ethics. Because each of the theories has several variations, they can also be regarded as moral traditions that remain vibrant today.

As we proceed, we will take note of major variations within each theory (...

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