Professional practice 1

Class Room Code of Conduct:Be on time, be on task, be prepared.

Demonstrate respect for yourself, other students and property.

Behave appropriately at all times. Bee quiet while working .Mobile phones are not allowed during the class

session.Students having attendance less than 75% will not be

allowed to sit in sessional or terminal examinations .Submission of Assignment on proper time.

Marking System1. Paper Marks 75

A) MCQs 50

B) Subjective 25

2. Viva 15

2. Assignments 10

Course IntroductionThe course will discuss the role, responsibility, ethics

administration issues and accountability of the physical

therapists .

The course will also cover the change in the profession

to the doctoral level and responsibilities of the

professional to the profession, the public and to the

health care team.

Health care system in Pakistan with comparison with

current health system abroad will be discussed too

Responsibilities of a Physical Therapist as an individual.To provide Quality care

To be involved in an ethical and legal practice.

To keep him/her self update about the new developments in the field.

To be an evidence based clinician for the quality care.

To be a trust worthy professional.

The role and responsibilities of Physical Therapist as member of the professionTo educate the other health care team about

the scope of physical therapy.

To educate the general public how a physical therapist can help the community to live a healthy life.

To play an active role for the development of the profession.

To participate in the research studies.

Ethics in Physical Therapy PracticeEthics: A major branch of philosophy,

encompasses right conduct and good living.

Meta-ethics: about the theoretical meaning and reference of moral propositions and how their truth-values (if any) may be determined .

Normative ethics: about the practical means of determining a moral course of action .

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Applied ethics: about how moral outcomes can be achieved in specific situations;

Descriptive ethics :about what moral values people actually abide by.

Cont…What is right for the patients.

Most patients allow us to touch their backs, necks, or extremities in ways that would not occur in society in general, so we must not misuse this position.

Physical Therapists must also consider how stressful it is for patients when they come to us for care.

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A trusting relationship should develop between the therapist and patient .

Confidentiality is a crucial matter in daily practice.

Issues in daily PracticeConfidentiality

Sexual harassment

Misleading patients

Kick backs

Time management

Supportive stuff behavior

Quality care

Principles of Health Care EthicsRespect for Autonomy NonmaleficenceBeneficence Common Good Distributive Justice Double Effect Human Dignity Informed Consent Integrity and Totality Proportionate and Disproportionate Means Religious Freedom Respect for Persons Subsidiarity Toleration

Respect for AutonomyAutonomy is the capacity for self-determination .

To acknowledge that person’s right to make choices and take action based on that person’s own values and belief system .

The principle of respect for autonomy implies that one should be free from compulsion in deciding to act, and that others are obligated to protect confidentiality, respect privacy, and tell the truth .

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In the practice of health care, a person’s autonomy is exercised through the process of obtaining informed consent.

however, does not imply that one must cooperate with another’s actions in order to respect that individual’s autonomy.

Nonmaleficence

The principle of nonmaleficence is an obligation not to inflict harm intentionally.

Most persons who choose a health care career only want to help people, not harm them.

Continue….One way to remember the meaning of this

principle is to think of the phrase in the Hippocratic oath,

"To first do no harm." Usually issues of Nonmaleficence are discussed when patients are at the end of life.

We often must decide if continuing treatments cause the patient more harm than benefit.

BeneficenceThe principle of beneficence is a moral

obligation to act to benefit others.

There are, however, risks associated with beneficence. Sometimes we want to help our patients so much, that we begin to believe that we know what is best for them.

We sometimes believe that they should do whatever we recommend since we have the most knowledge about their condition.

Continue….When we believe that we know what is best for

a patient even when they do not agree, we risk stepping over the boundary from beneficence to paternalism. When this happens, the patient's autonomy is not respected.

If you find that you are trying to convince patients to do things your way by saying, "It is for your own good," you might be using a form of paternalism.

The Common GoodThe common good consists of all the

conditions which allow individuals to achieve human and spiritual flourishing in promoting the health and welfare of every citizen.

According to this understanding, the principle of the common good has three essential elements: 1) respect for persons; 2) social welfare; and 3) peace and security.

Continue….These elements entail the provision of

health care in some way as an essential element of the common good .

To provide free or equal health care to each individual of the society is the key responsibility of Government.

Distributive JusticeIn the context of health care, distributive

justice requires that everyone receive equitable access to the basic health care necessary for living a fully human life insofar as there is a basic human right to health care.

Everyone is entitled to equal access to basic care necessary for living in a human way.

Continue…..In other words, allocation decisions

should not be based upon judgments of the quality of persons. Benefits and burdens should also be distributed in a just manner.

For example, health care is a benefit that should be fairly distributed and taxes are a burden that we also try to share fairly.

Double EffectMeans Good Effect or Evil Effect.

Every persons intrinsic action is accordance to the laws of fundamental commitments to Allah.

In respect to physical therapy the therapist intentions are to achieve the beneficial effects not the harmful effects of correct exercise prescription or any modality used.

Strong evidence based Knowledge is necessary to achieve the Good effects.

Human DignityOne direct normative implication of human

dignity is that every human being should be acknowledged as an inherently valuable member of the human community and as a unique expression of life, with an integrated bodily and spiritual nature.

Human dignity is the conceptual basis for human rights, health care delivery system is the right of every human being irrespective of religion.

Informed ConsentThe ability to give informed consent depends

on: 1) adequate disclosure of information; 2) patient freedom of choice; 3) patient comprehension of information; and 4) patient capacity for decision-making.

By meeting these four requirements, three necessary conditions are satisfied:

1) that the individual’s decision is voluntary; 2) that this decision is made with an appropriate understanding of

the circumstances; and 3) that the patient’s choice is deliberate insofar as the patient has

carefully considered all of the expected benefits, burdens, risks and reasonable alternatives.

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Legally, adequate disclosure includes information concerning the following .

1) diagnosis; 2) nature and purpose of treatment; 3) risks of treatment; and 4) treatment alternatives.

Integrity and TotalityThese principles dictate that the well-being of

the whole person must be taken into account in deciding about any therapeutic intervention or use of technology .

Every part of the human body "exists for the sake of the whole as the imperfect for the sake of the perfect" .

Mostly happens in acute health care.

Proportionate and Disproportionate Meansordinary/extraordinary means The principle holds that one is obligated to

preserve his or her own life by making use of ordinary means, but is under no obligation to use extraordinary means .

when a medical intervention or "means" is proportionate, one has a general obligation--all things considered--to accept the treatment. When the medical intervention constitutes a disproportionate means, then one is no longer obliged to undergo the treatment.

Continue…..means is any treatment that, in the given

circumstances, offers a reasonable hope of benefit and is not too burdensome for the patient or others.

What is a reasonable hope of benefit to the patient should be judged within the context of the whole person (i.e., considered holistically, not just physiologically).

Religious FreedomThis principle implies that competent

individuals should never be forced to act in a manner contrary to their religious beliefs , This principle applies equally to patients, physicians, Therapists, nurses and others who work in any health care facility.

If Patient then, intimate the Risk factors to life .

Doctors . Have to pay liability.

Respect for Persons

As a subject, and not merely an object, a human person must be treated with respect in such a way that recognizes his or her human dignity.

SubsidiarityThe principle implies that, when a decision is to be

made, we should identify the most appropriate forum and level of decision making,

subsidiarity requires those in positions of authority to recognize that individuals have a right to participate in decisions that directly affect them, in accord with their dignity and with their responsibility to the common good.

Physical therapist must be involved in the decision making process in their relevant departments.

TolerationThe Principle of Toleration was developed as a

set of moral criteria for judicious how to pursue good in a world in which evil is inevitable.

According to this principle, those who govern both society and the individual institutions that constitute important elements of the common good may at times—where prudence dictates—tolerate the evil actions of other health care professionals

Assignments -1

A PT has been providing physical therapy for 40 year old women with a cervical pain for 2 weeks but the pain has not been abated. with the patients permission, the PT asked an other therapist in the same clinic to consult on the case. when the consulting PT begin an examinations ,the patient complaints of jaw pain and leaves without further interventions. At this point the consulting PT read the patients chart and discover that she has a history of TMJ problem .After several TMJ surgeries the patient sues both PTs for malpractice and negligence.

THANKS