Ethical Issues Relevant to Physical Therapy.

Ethical Issues Relevant to Physical Therapy

Geddes EL, Finch E, Larin H. Hamilton, Ontario, Canada L8S 4K1, School of Rehabilitation Science, McMaster University, 1999, paperback, 115 pp, ISBN: 096851880X, $40.

According to the authors, this book was developed as a resource for the students, faculty, and clinicians associated with the physical therapist education program at McMaster University as they integrated ethics into their problem-based curriculum. The authors recognized the increasing importance of ethical decision making in clinical practice and wanted to provide a text that discusses the ethical issues of primary importance to physical therapists.

Focus groups of students, faculty, and clinicians identified 40 ethical issues, and the authors selected 12 of them to appear in this book. A separate chapter is devoted to each issue. The issues are informed consent, truth telling, privacy and confidentiality, nondiscrimination and respect for individual differences, experimental treatment, organ transplant and donation, end-of-life decisions, quality of life, allocation and rationing of scarce resources, advocacy for the client, societal well-being, and ethics of professional collegiality. Because the book's purpose is to promote decision making, it would have been helpful if the authors shared with us how they selected these 12 ethical issues.

Each chapter has a brief discussion of the issue and is followed by an annotated bibliography. At the end of each citation is a list of key concepts. The authors provide an appendix with the physical therapy codes of ethics for the American Physical Therapy Association, the Canadian Physiotherapy Association, the New Zealand Society of Physiotherapists, and the World Confederation for Physical Therapy. A bibliography follows the appendix. All of the references that appeared in the chapters are listed along with some additional citations.

The strength of this volume lies in its annotated references and its appendix. The references contain synopses of 27 articles, chapters, and books and are referenced by ethical issue, providing a handy resource for people who would like to explore each subject. An excellent exercise for students of physical therapy ethics would be to compare and contrast the 4 codes of ethics in the appendix.

Readers should also be aware that this book does not provide the intellectual tools that physical therapists need to gain an in-depth understanding of ethical dilemmas. The authors' comments tend to oversimplify the issues and fail to state the basic values that are in conflict. For example, in the chapter on privacy and confidentiality, the authors never define these terms or distinguish them from each other. In the chapter on informed consent, the authors state that, for patients to be able to make rational decisions, they need information that is complete, accurate and comprehensible. Physical therapists need the same kind of information when confronting ethical issues.

Another weakness of the book is what I believe to be erroneous material contained in the authors' comments. For example, in the "Introduction," the authors attribute the principle of "Do no harm" to Hippocrates and the prominence of autonomy in medical ethics to "feminist scholars." Neither of these statements is true.

Jan Bruckner, PT, PhD Thomas Jefferson University Philadelphia, Pa

Dr Bruckner is the Director of Research for the Department of Physical Therapy. She has published articles and book chapters on ethics in physical therapy.