Biomedical subjects
Publications and source records attributed to R B Purtilo.
When there is a scarcity of resources (therapists, modalities), the physical therapist must make decisions about whom to treat and why. This paper discusses ethical dilemmas confronting the therapist and addresses solutions based on approaches of procedural justice and distributive justice.
The high standards of medical practice rest on the assumption that a physician's competence equips him or her to act on a patient's behalf. The conundrum created by medical uncertainty regarding the patient's diagnosis or the appropriate course of treatment seldom receives attention in the medical literature. This article highlights how the age-old medical ideal of beneficence, the modern concept of probabilities, the added dimension of treatment modification based on patients' preferences, and a compassionate disposition operate as competence-supporting tools in high uncertainty medical situations.
A possible abrogation of the health professional's usual duty to treat sometimes is suggested in regard to patients with acquired immunodeficiency syndrome (AIDS). The issue first arose and continues to be discussed in regard to those patients who have contracted AIDS through homosexual encounters, though there are now additional populations of patients with AIDS to whom the issue is being directed as well. We examine three lines of reasoning that may be advanced to support this view: the argument from morality, the argument from responsibility, and the argument from the alleged danger to others. We show logical and ethical shortcomings in each view and suggest how the physical therapist's duty to treat all patients who have AIDS can be realized in a safe and supportive environment.
Perplexing ethical and legal concerns cross health professions and reach into many professions and vocations. Confidentiality is crucial not only to the health professional and the patient, but also to the lawyer and client, and the investigative reporter and the source. Reporting poor work or whistleblowing is a dilemma not only for dentists and other health care professionals, but also for the engineer, architect, and federal employee, among others. This survey of the ethical or legal perceptions of the dental practitioner supports two conclusions: perplexing situations are perceived as predominantly ethical rather than legal problems and the factor of age (number of years in practice) might affect this trend toward the ethical consideration of complicated issues. Understanding the nature of these and other perplexing situations requires that dental practitioners step beyond the confines of their practice and the boundaries of the dental profession to search for more effective ways of dealing with, and therefore living with, the realities of their practice.
Comprehensive health care requires the collaboration of several health care disciplines and perspectives. Physical medicine and rehabilitation, with its explicit emphasis on the candidate's physical, psychosocial, and emotional well-being, understandably has depended on a team arrangement from its very beginnings. In spite of its shortcomings, a team approach, guided by well-formulated moral policies, provides ample opportunities for the rehabilitation candidate's best interests to be served.
Physical therapists express their respect for patients by providing competent, compassionate care. Constraints may be imposed on realizing this ideal when treatment must be refused or discontinued because patients lack the financial resources to pay for physical therapy services. The purposes of this article are 1) to review key features that have contributed to the current high cost of health care, 2) to describe approaches being proposed to curb costs, and 3) to suggest ways physical therapists can have a constructive role in creating rational cost-containment policies that are consistent with professional ideals. Seven activities by which physical therapists can become involved at the health care policy level are discussed.
Two important ethical concerns facing physicians and others involved in the management of ventilator-dependent patients in the medical rehabilitation environment are: the cost of employing the respirator and the accompanying allocation issues entailed in that consideration, and the quality of life the ventilator imposes on or improves for a patient. Present practices are described and analyzed and suggestions are made for how physiatrists can constructively address key problems which arise in the profession's attempt to act in accord with high ethical standards of practice.
Recent research has identified the human T-lymphotropic virus type III (HTLV-III) as a probable etiologic agent of the acquired immune deficiency syndrome (AIDS). This has prompted the U.S. Public Health Service to recommend that all blood used for transfusions or in the manufacture of blood products be screened. An enzyme-linked immunosorbent assay (ELISA) has been approved for use as a screening test. From the perspective of the low-risk blood donor, however, our analysis indicates that the expected utility of no-testing may exceed that of testing. This is primarily due to the risk of a false-positive test result. It follows that informed low-risk individuals may be hesitant to donate blood. We support the discarding of blood that tests positive on ELISA but, to decrease donor risk, a positive confirmatory test, such as the Western blot, should be considered as necessary before the testing outcome is treated as positive from the donor's perspective. Additionally, individuals should be given the option to donate blood without being told the testing outcome.
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The purpose of this presentation is to increase the physcial therapist's understanding of the current concept of a "right to health care" and to explore the moral implications for physical therapy arising out of the various interpretations currently being advanced. The term "right" is used in two ways: 1) "freedom right," providing freedoms from certain types of interferences and 2) "entitlement rights," calling for positive action on the part of others. The right to health care is viewed as an entitlement right. As such, it has been variously interpreted as a praiseworthy ideal or an imperative upon society. The moral implications associated with accepting either position are briefly examined, giving special attention to the dilemmas and promises posed for physical therapists in both positions.
Courses called "Ethics" have long been included in physical therapy education programs. This paper reports the findings of a survey designed to assess current practices in teaching ethics in baccalaureate-level physical therapy programs. Of 59 questionnaires sent, 29 were returned and analyzed. The findings are compared with similar recent surveys of medical and nursing schools. Suggestions are made for assuring that the high standard of teaching maintained in other areas of physical therapy professional preparation also are maintained in ethics teaching.
Physical therapists are not always involved in the formulation of moral policy that significantly affects their professional practice as clinicians, researchers, and educators. This paper analyzes five major positions being taken regarding what the physical therapist's role ought to be, and suggests possibilities for increased involvement in the policy-making process.
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This paper surveys selected historical foundations of the present American Physical Therapy Association's CODE OF ETHICS, showing the extent to which the present code draws upon oaths, ideas in ethics textbooks, and other sources. The article presenta a basis for understanding the significance of these historical influences and provides one means by which physical therapists can more fully appreciate the relevance of the code today.
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Physical therapists sometimes hesitate to treat terminally ill patients because they believe the approach to them should differ from the approach to other patients. This belief is based on the assumption that patient needs during terminal illness differ from the needs of other patients. Some important similarities in patient reactions to chronic and terminal illness are explained. A conceptual framework of 'little deaths' is presented for comparing the two types of illness.
Physical therapists have an increasing need to incorporate an ethics perspective into their professional outlook. One way a physical therapist can become more proficient in recognizing morally significant data is to identify such data in articles written by physical therapists and other health professionals. An article should be evaluated according to the facts included or omitted, the loyalties expressed by the author, the life-view implied by the author, and the norms of good and right directing the author's thinking.