2. P.PONMATHI
Faculty of Physiotherapy
CONCEPTS IN ETHICS AND MANAGEMENT OF
HEALTH CARE DELIVERY
“Ethics is knowing the difference
between what you have a right to do
and what is right to do.”
– Potter Stewart, former U.S. Supreme Court Justice
3. P.PONMATHI
Faculty of Physiotherapy
ETHICAL PRINCIPLES FOR PHYSIOTHERAPY
PRACTICE
1.AUTONOMY
2.BENEFICENCE
3.CONFIDENTIALITY
4.DO NO HARM/NON-MALEFICENCE
5.EQUITY OR JUSTICE
5.SOCIAL RESPONSIBILIY
5. P.PONMATHI
Faculty of Physiotherapy
AUTONOMY
The right of patients to make decisions
about their medical care
Patient autonomy does allow for
health care providers to educate the
patient
But does not allow the health care
provider to make the decision for the
patient.
6. P.PONMATHI
Faculty of Physiotherapy
1.Patient should have no mentally sound
2.This right of choice is not limited to
decisions which others might regard as
sensible.
3.It exists notwithstanding that the reasons for
making the choice are rational, irrational,
unknown or even non-existent.
Lord Donaldson. Re T (Adult) [1992] 4 All ER 649.
AUTONOMY
7. P.PONMATHI
Faculty of Physiotherapy
1.Have we explained fully the patient’s medical
condition, their options for treatment and the
advantages and disadvantages of those treatments?
2.Is the patient able to retain this information,
evaluate their options and arrive at a decision?
3.Has the patient provided informed consent for
our actions?
.
AUTONOMY TO CONFIRM
8. P.PONMATHI
Faculty of Physiotherapy
1.Someone is being coerced
2.Where patients lack the capacity to make a decision,
very young children ordinarily have the majority of
decisions made by parents and carers.
3.Where adults lack capacity, health care decisions are
ordinarily made by the health professional in overall
charge of their care, although adults can appoint
someone to make decisions on their behalf.
DECISIONS WHERE AUTONOMY IS LACKING
9. P.PONMATHI
Faculty of Physiotherapy
A patient has been referred for the physiotherapy management of
posttraumatic stiffness of knee joint.CPM is advised for the patient and its
advantage is explained to the patient and negative effects of immobility is
also explained .Despite understanding the procedure in detail,he refused for
the treatment
What will be appropriate step?
1.Respect his wishes and do not exercise him with CPM
2.Get consent from his wife and continue the treatment
3.Leave the patient to become physically disable
EXAMPLE…..
10. P.PONMATHI
Faculty of Physiotherapy
Autonomy should not necessarily be seen as ‘patient control of decision-
making,’ but as a clinical reality which consists of education, conversation
and concern for patient wellbeing.
Beyond this, the issues must be resolved using appropriate moral reasoning,
clear communication, comprehensive assessment of the situation, respect
empathy and personal judgement.
To conclude…
12. P.PONMATHI
Faculty of Physiotherapy
To provide all the benefits of our professional knowledge to help the person
overcome their dysfunction.
Beneficence implies action of “kindness, mercy, or charity” toward others
Beneficence is the ethical duty of physicians to act in the patient’s best
interest
BENEFICENCE
13. P.PONMATHI
Faculty of Physiotherapy
1.Will this option resolve this patient’s problem?
2.Is it proportionate to the scale of the problem?
3.Is this option compatible with this patient’s
individual circumstances?
4.Is this option and its outcomes in line with the
patient’s expectations of treatment?
APPROACH BENEFICENCE
14. P.PONMATHI
Faculty of Physiotherapy
If a patient denies keeping wax to knees on
religious grounds and a therapist decides to
provide it anyway, the therapist has taken away the
patient’s autonomy. Although the therapist may
have reduce pain in one way, the therapist has
taken away the patient’s clearly defined right to
choose her own course of treatment.
EXAMPLES
15. P.PONMATHI
Faculty of Physiotherapy
Beneficence asks us to promote a course of action, but in practice we also
need to de-promote certain courses of action if there are better options
available
To conclude....
17. P.PONMATHI
Faculty of Physiotherapy
1. Maintaining confidentiality is both a legal and
ethical responsibility of healthcare
professionals.
2. Trust between physiotherapist and patients
3. Before providing informations regarding
patients seek patients consent.
4. Anonymise data where unidentified data will
serve the purpose
5. Keep disclosures to the minimum necessary
CONFIDENTIALITY
18. P.PONMATHI
Faculty of Physiotherapy
6.Discuss only aspects of the patient that are important to the treatment of the
individual
7.Discuss aspects of care only in a confidential atmosphere
8.Ensure that patient records are not deposited in places of public access.
9.not discuss one patient’s condition (1) with another patient (2) without the
consent of the first party
Confidentiality
19. P.PONMATHI
Faculty of Physiotherapy
Autonomy
For Patient Confidentiality:
Breaking confidentiality without the
patient’s consent undermines the
patient’s wishes..
Against Patient Confidentiality:
This means that in some cases
autonomy can be nullified. An
example of this is if the patient has
told you that they have participated
in serious illegal activity or that they
intend to hurt someone
Confidentiality
Beneficence and Non-Maleficence
For Patient Confidentiality:
The doctor’s priority should be their
patient’s health and wellbeing.
Occasionally breaking confidentiality
means that the patient will get into trouble
(e.g. with the police or their parents if it’s a
child)..
Against Patient Confidentiality:
Sometimes patients do not comprehend the
consequences of keeping information secret
and they will often have a biased view. But
as a therapist your main aim will be to do
what is best for your patient.
20. P.PONMATHI
Faculty of Physiotherapy
Justice
For Patient Confidentiality:
The public’s perception of healthcare professionals can be tarnished if
doctors are seen to disregard the importance of confidentiality.
Against Patient Confidentiality:
It is a doctor’s duty to always consider the impact of a situation on society
as a whole. If a doctor finds out information which will assist non-healthcare
services (e.g. police/social services/DVLA) in protecting the public then it is
their responsibility to disclose it if the patient has adamantly refused to.
Confidentiality
21. P.PONMATHI
Faculty of Physiotherapy
For example, when pressed for time, providers may be tempted to discuss a
patient in the elevator or other public place, but maintaining privacy may
not be possible in these circumstances
EXAMPLE
22. P.PONMATHI
Faculty of Physiotherapy
The obligation of confidentiality prohibits the health care provider from
disclosing information about the patient's case to others without permission
and encourages the providers and health care systems to take precautions to
ensure that only authorized access occurs.
Stay informed about your state and local policies, as well as institutional
policies, governing exceptions of patient confidentiality.
To conclude
24. P.PONMATHI
Faculty of Physiotherapy
Duty of the health provider to ensure that
justice is done to the individuals in her care.
This involves equal and unbiased care,
respect for autonomy, and the duty to
provide the correct information to the best of
her knowledge if called upon by a court of
law.
JUSTICE
25. P.PONMATHI
Faculty of Physiotherapy
Consider the following aspects:
1.Is this action legal?
2.Does this action unfairly contradict
someone’s human rights?
3.Does this action prioritise one group over
another?
4.If it does prioritise one group over another,
can that prioritisation be justified in terms of
overall net benefit to society or agree moral
conventions?
JUSTICE
26. P.PONMATHI
Faculty of Physiotherapy
A patient with more pain is given referral once in 2
days where as other patients with less pain will be
given weekly twice.
One could argue that the prioritisation of these
patients over others perhaps infringes the universal
right of all patients to receive timely access to
healthcare services
EXAMPLE
28. P.PONMATHI
Faculty of Physiotherapy
Oldest principle of medical behaviour- do
no harm.
It states that a medical practitioner has a
duty to do no harm or allow harm to be
caused to a patient through neglect.
NON-MALEFICENCE
29. P.PONMATHI
Faculty of Physiotherapy
In order to prevent harm to patients, we therefore need to consider the
following aspects:
What are the associated risks with intervention or non-intervention?
Do I possess the required skills and knowledge to perform this action?
Is the patient being treated with dignity and respect?
Is the patient being put at risk through other factors (e.g. staffing, resources,
etc.)?
NON-MALEFICENCE
30. P.PONMATHI
Faculty of Physiotherapy
Non-maleficence differs from beneficence in two major ways.
First of all, it acts as a threshold for treatment. If a treatment causes more
harm than good, then it should not be considered. This is in contrast to
beneficence, where we consider all valid treatment options and then rank
them in order of preference.
Second, we tend to use beneficence in response to a specific situation – such
as determining the best treatment for a patient. In contrast, non-maleficence
is a constant in clinical practice. For example, if you see a patient collapse in
a corridor you have a duty to provide (or seek) medical attention to prevent
injury.
To conclude
34. P.PONMATHI
Faculty of Physiotherapy
Westra et al suggest that the four principles approach may be very helpful in
analysing ethical dilemmas, but when communicating with patients with
different backgrounds, an alternative approach is needed that pays genuine
attention to the different backgrounds.
CONCLUSION
35. P.PONMATHI
Faculty of Physiotherapy
One hypothetical case study involves a patient who has an ovarian cyst that, left untreated, will
result in kidney failure. An operation to remove the cyst is the best treatment, but the patient is
frightened of needles and is against the surgery that would require a needle to give her
anesthesia. The doctor must work with the patient to respect the fact that she dislikes needles
and doesn’t want the operation (her autonomy), and needs to find a solution that would prevent
her from going into kidney failure, which is in her best interest (beneficence). Although the
surgery is the best choice, forcing the patient to accept the needle would be harmful to her (non-
maleficence). Finally, the doctor needs to consider the impact that the patient’s choices might
have on others if she starts to go into preventable kidney failure, she’ll need dialysis, which
affects other people who need the sam treatment (justice). So before making the final decision
the doctor must consider all four principles of health care ethics, which will help the physician
make the choice that will have the best possible benefits for both the patient and society.
TOGETHER
