Class Room Code of Conduct:
Be on time, be on task, be prepared.
Demonstrate respect for yourself, other students and
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.
1. Paper Marks 75
A) MCQs 50
B) Subjective 25
2. Viva 15
2. Assignments 10
The course will discuss the role, responsibility, ethics
administration issues and accountability of the physical
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
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 profession
To 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
To participate in the research studies.
Ethics in Physical Therapy Practice
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 .
Applied ethics: about how moral outcomes can be
achieved in specific situations;
Descriptive ethics :about what moral values people
actually abide by.
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.
A trusting relationship should develop between the
therapist and patient .
Confidentiality is a crucial matter in daily practice.
Issues in daily Practice
Supportive stuff behavior
Principles of Health Care Ethics
Respect for Autonomy
Integrity and Totality
Proportionate and Disproportionate Means
Respect for Persons
Respect for Autonomy
Autonomy 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 .
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
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.
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.
The 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.
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
The Common Good
The 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
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
In 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
Everyone is entitled to equal access to basic care
necessary for living in a human way.
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.
Means 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.
One 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.
The 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
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.
Legally, adequate disclosure includes
information concerning the following .
2) nature and purpose of treatment;
3) risks of treatment; and
4) treatment alternatives.
Integrity and Totality
These 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
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
means is any treatment that, in the given
circumstances, offers a reasonable hope of benefit
and is not too burdensome for the patient or
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
This 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.
The principle implies that, when a decision is to be made, we
should identify the most appropriate forum and level of
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.
The 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
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.