Since Ancient Greece, people have been considering the philosophical question: How do we live a good life together? Often this question is reduced to: What is right and wrong behavior in a particular situation in order to not cause unjustified harms?
To attempt to answer these questions, a common starting point is morality. Morality can be defined as societal or group codes of conduct about right/wrong (or good/bad) behavior that individuals who live in those societies and groups agree to in order that all can live a flourishing life. These codes of conduct are either legal, ethical, or customary to specific groups. How does this affect physical therapy practice?
First, we have a plethora of laws to follow. From local laws to our state practice acts to CMS’s national billing and utilization laws with many other laws in between. As practicing physical therapists, we are required to follow these laws. If we don’t, whether by ignorance or choice, then we can be punished for breaking these laws. Everyone seems to know this and yet, some still break laws and suffer the societal consequences.
Legal behavior is our minimal standard of behavior. Societal rules become laws through legislation and are enforced by a society with punishment to those members who break the laws. Ethical behavior is a higher standard that is based on the theories, principles, and rules set out by ethics as a branch of the academic discipline of philosophy. Ethics is “a systematic study of and reflection on morality” (Doherty & Purtilo, 2106). Within ethics, there are judgments delineating which behaviors are prohibited, permitted, required, and ideal.
Second, ethical standards of physical therapy practice are particularly laid out in the APTA’s “Code of Ethics” and its accompanying “Guide to Professional Conduct” (APTA website). Our professional code, like most professional codes, is based on a philosophical concept called principlism which simply sets forth principles that govern right and wrong behaviors. The ATPA Code of Ethics lists eight principles with each principle containing a set of sub-principles. Professional Codes of Ethics are written by professionals within an organization to protect the profession and to guide the professionals. While our state practice acts are the legalized agreement that our profession has with the society we serve, our Code of Ethics is our social agreement with the society we serve. Both are the way we, as a profession, foster trust with the public.
Last, all of us have specific groups that we belong to such as a church community, a political party, or an activist group that has their own codes of conduct aligned with an ideology or perspective toward community life. It is our preference and choice to join or leave these groups according to our agreement with their codes of conduct.
These different types of codes of conduct rarely align and more often create tensions within individuals. One may personally agree or disagree with any of them in varying degrees. However, in our society, a physical therapist as a citizen must follow the laws. As a professional, they should follow the Code of Ethics, and as a member, they may follow their chosen group’s rules. However, all three types of codes of conduct change in historically and culturally significant ways. Practicing physical therapy today is very different than in the 1970’s because many of the legal changes reflect the professional development of physical therapy practice. Also, our current APTA Code of Ethics which was updated and passed in 2009 is very different from the original American Physiotherapy Association’s Code of Ethics and Discipline passed in 1935.
An ethical person is self-aware, self-critical, and self-reflective. Feel free to send comments to email@example.com. Debra Gorman-Badar, PT, MA, PhD student, Chair, MAPTA Ethics Committee