Ethics is defined as the discipline dealing with what is good and bad and with moral duty and obligation. For the physical therapy assistant, it means a standardized conduct geared towards proper and successful patient care. The physical therapist assistant follows a certain standard for ethical conduct to effectively aid physical therapists and to be sensitive and efficient health workers. In this situation, we are dealing with the case of a 35 year old stressed-out woman with an odd behavior, who later on presented with slurring of speech.
Slurring of speech can be due to many factors but majority of which are associated with cerebrovascular disease or stroke. In this situation, we are going to apply the American Physical Therapy Association Standards of Ethical Conduct for the Physical Therapist Assistant. The seven standards of ethical conduct seem to show us the values of an ideal physical therapy assistant: respect, trustworthiness, competence, compliance to legislations and responsibility. In analyzing this case, we realize various problems. At the start of the session, the patient was behaving oddly.
Although she claims to be euphoric, signs of lethargy still seemed apparent. Later on, she succumbs to this lethargy or generalized body malaise by falling asleep on the mat. Later on, she manifests slurring of speech, which may be due to some problems. The most common cause of slurring of speech is stroke. Other factors that may cause this manifestation are electrolyte imbalance caused by strenuous physical activity, side effects of medications or it is simply due to drowsiness. However we see an imminent danger; she lives far from the clinic where you live and wants to drive all by herself—in her condition.
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We quickly realize a possible outcome—the danger of meeting accidents on the road in her condition. Recognizing our problem, some of our values as physical therapist assistants are challenged. The situation challenges our respect towards our client. Respect is defined as consideration and the avoidance of interfering with or intruding upon. In this case, we are breaching against the right of the patient to make her own decisions. We seem to not respect this right because we want to have things done our own way and not hers. Thus, this situation does not only concern our patient; it also concerns the physical therapy assistant.
In this situation, we are having a patient-health care professional relationship. In turn, this situation challenges us to practice the rest of the 7 standards of ethical conduct. This situation motivates us to practice trustworthiness towards our patient. In this sense, we should show our patient how worthy we are of their trust towards us. We should show them that we are concerned about their health and well-being. We should explain to our patient that we think driving in our condition poses a hazard to her and makes her prone to road accidents.
By doing this, we should tell her our real intention—that we are just after her health and safety. Standard 6 of American Physical Therapy Association Standards of Ethical Conduct states that a physical therapy assistant shall make judgments that are commensurate with their educational and legal qualifications as a physical therapist assistant. Judgment per se means “good sense”, discernment, understanding, the act or mental faculty by which man compares ideas and ascertains the relations of terms and propositions. In this situation, we discern that our patient should not continue driving her own car alone.
In our understanding, she is not fit to do it and we are subjecting the patient to harm and injury, as she is prone to accidents in her present condition. Also, it is in our discernment that she should go to the nearest hospital to have her neurological status assessed and her health problems addressed properly. By doing these things, we are fulfilling Standard 7, which states that a physical therapist assistant should protect the public and the profession from unethical, incompetent and illegal acts. In addition to the above values, this situation requires moral sensitivity, moral judgment, moral motivation and moral courage.
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All these individual processes are needed in our situation. Morality means conformation to the principles of good conduct and virtue. By being morally sensitive, we mean that we are easily affected and moved towards betterment and towards good conduct. In our case, we are moved towards helping our patient and towards helping her attain good health and well being. We are moved towards preventing her from being alone, and we are moved towards accompanying her to the nearest medical hospital so that proper medical attention shall be given. Moral judgment means discernment towards the good of the patient.
We discern what is best of her. We anticipate the accidents she will be at risk of and the many problems that may be etiologies of her neurological deficit. Motivation is defined as a process which incites to action and the determination of the choice or movement of will. In that case, moral motivation is also applicable in this situation. We are moved towards helping our patient; our action is for her good health and safety. Moral change is also needed in our situation. It is the process of encountering danger and difficulties with firmness and with intrepidity, for a good and noble cause.
We have the courage to act for the well-being of our patient and we go beyond our duties to ensure her safety. This situation does not only involve the physical therapy assistant and the patient, it also involves the family members. In this case, it is proper that we talk to the other family members about the patient’s condition. It is essential to differentiate four terms in this context: the terms problem, dilemma, distress and temptation. A problem is defined as a question proposed for solution, decision or determination; a knotty point requiring clarification.
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A dilemma means a situation requiring a choice between equally objectionable alternatives; a problem that seems incapable of being resolved satisfactorily. Distress means extreme pain, anguish of the body or mind; that which causes suffering, affliction, calamity, adversity, misery and calamity. The term temptation means an enticement to an act which is evil, immoral or unwise. Yes, our situation is a problem by itself; it needed immediate solution and decision. It is also a dilemma because it poses a choice—whether to let the patient do what she wants or to accompany her to the nearest hospital beyond our duty hours.
Our situation is not necessarily a distress but is a prelude to suffering, injury and misery. Certainly, this is not a temptation per se but temptation lurks for every health care professional who counts his or her duty days and does not extend his or her duty in terms of danger or calamity. The dictum for every health care professional is: Love your work. Temptation to do things our way and to be selfish and insensitive to the needs of our patients is a barrier to every health care professional. There are some health care professionals who punch in at 8 AM and go home at 5PM, regardless of what happens to their patients.
These are the type of health care professionals who think of their jobs as routine and who takes these jobs as just a job for financial security, but is not their career. A career is something a person puts his or her heart into. As health care professionals, we must think of caring for patients as a career, not as a routine job. This problem, obviously, is not treated with silence. It entices action of the health care professional who cares deeply for his or her patients. In this sense, the situation requires a moral action, brought about by moral sensitivity, judgment, motivation and courage.
