Guide for Professional Conduct.

PURPOSE

This Guide for Professional Conduct (Guide) is intended to serve physical therapists who are members of the American Physical Therapy Association (Association) in interpreting the Code of Ethics (Code) and matters of professional conduct. The Guide provides guidelines by which physical therapists may determine the propriety of their conduct. The Code and the Guide apply to all physical therapists who are Association members. These guidelines are subject to changes as the dynamics of the profession change and as new patterns of health care delivery are developed and accepted by the professional community and the public. This Guide is subject to monitoring and timely revision by the Judicial Committee of the Association.

INTERPRETING ETHICAL PRINCIPLES

The interpretations expressed in this Guide are not to be considered all inclusive of situations that could evolve under a specific principle of the Code but reflect the opinions, decisions, and advice of the Judicial Committee. While the statements of ethical principles apply universally, specific circumstances determine their appropriate application. Input related to current interpretations, or to situations requiring interpretation, is encouraged from Association members.

PRINCIPLE 1

Physical therapists respect the rights and dignity of all individuals.

1.1 Attitudes of Physical Therapists

   A. Physical therapists shall recognize that each individual is different
   from all other individuals and shall respect and be responsive to those
   differences.

   B. Physical therapists are to be guided at all times by concern for the
   physical, psychological, and socioeconomic welfare of those individuals
   entrusted to their care.

   C. Physical therapists shall not engage in conduct that constitutes
   harassment or abuse of, or discrimination against, colleagues, associates,
   or others.

1.2 Confidential Information 

   A. Information relating to the physical therapist/patient relationship is
   confidential and may not be communicated to a third party not involved in
   that patient's care without the prior written consent of the patient,
   subject to applicable law.

   B. Information derived from component-sponsored peer review shall be held
   confidential by the reviewer unless written permission to release the
   information is obtained from the physical therapist who was reviewed.

   C. Information derived from the working relationships of physical
   therapists shall be held confidential by all parties.

   D. Information may be disclosed to appropriate authorities when it is
   necessary to protect the welfare of an individual or the community. Such
   disclosure shall be in accordance with applicable law.

1.3 Patient Relations

   Physical therapists shall not engage in any sexual relationship or
   activity, whether consensual or nonconsensual, with any patient while a
   physical therapist/patient relationship exists.

1.4 Informed Consent

   Physical therapists shall obtain patient informed consent before treatment,
   to include disclosures of: (i) the nature of the proposed intervention;
   (ii) material risks of harm or complications; (iii) reasonable alternatives
   to the proposed intervention; and (iv) goals of treatment.

PRINCIPLE 2

Physical therapists comply with the laws and regulations governing the practice of physical therapy.

2.1 Professional Practice

   Physical therapists shall provide consultation, evaluation, treatment, and
   preventive care, in accordance with the laws and regulations of the
   jurisdiction(s) in which they practice.

PRINCIPLE 3

Physical therapists accept responsibility for the exercise of sound judgment.

3.1 Acceptance of Responsibility

   A. Upon accepting an individual for provision of physical therapy services,
   physical therapists shall assume the responsibility for evaluating that
   individual; planning, implementing, and supervising the therapeutic
   program; reevaluating and changing that program; and maintaining adequate
   records of the case, including progress reports.

   B. When the individual's needs are beyond the scope of the physical
   therapist's expertise, or when additional services are indicated, the
   individual shall be so informed and assisted in identifying a qualified
   provider.

   C. Regardless of practice setting, physical therapists shall maintain the
   ability to make independent judgments.

   D. The physical therapist shall not provide physical therapy services to a
   patient while under the influence of a substance that impairs his or her
   ability to do so safely.

3.2 Delegation of Responsibility

   A. Physical therapists shall not delegate to a less qualified person any
   activity that requires the unique skill, knowledge, and judgment of the
   physical therapist.

   B. The primary responsibility for physical therapy care rendered by support
   personnel rests with the supervising physical therapist. Adequate
   supervision requires, at a minimum, that a supervising physical therapist
   perform the following activities:

      1. Designate or establish channels of written and oral communication.

      2. Interpret available information concerning the individual under care.

      3. Provide initial evaluation.

      4. Develop plan of care, including short- and long-term goals.

      5. Select and delegate appropriate tasks of plan of care.

      6. Assess competence of supportive personnel to perform assigned tasks.

      7. Direct and supervise support personnel in delegated tasks.

      8. Identify and document precautions, special problems,
      contraindications, goals, anticipated progress, and plans for
      reevaluation.

      9. Reevaluate, adjust plan of care when necessary, perform final
      evaluation, and establish follow-up plan.

3.3 Provision of Services

   A. Physical therapists shall recognize the individual's freedom of choice
   in selection of physical therapy services.

   B. Physical therapists' professional practices and their adherence to
   ethical principles of the Association shall take preference over business
   practices. Provisions of services for personal financial gain rather than
   for the need of the individual receiving the services are unethical.

   C. When physical therapists judge that an individual will no longer benefit
   from their services, they shall so inform the individual receiving the
   services. Physical therapists shall avoid overutilization of their
   services.

   D. In the event of elective termination of a physical therapist/patient
   relationship by the physical therapist, the therapist should take steps to
   transfer the care of the patient, as appropriate, to another provider.

3.4 Referral Relationships

In a referral situation where the referring practitioner prescribes a treatment program, alteration of that program or extension of physical therapy services beyond that program should be undertaken in consultation with the referring practitioner.

3.5 Practice Arrangements

   A. Participation in a business, partnership, corporation, or other entity
   does not exempt the physical therapist, whether employer, partner, or
   stockholder, either individually or collectively, from the obligation of
   promoting and maintaining the ethical principles of the Association.

   B. Physical therapists shall advise their employer(s) of any employer
   practice that causes a physical therapist to be in conflict with the
   ethical principles of the Association. Physical therapist employees shall
   attempt to rectify aspects of their employment that are in conflict with
   the ethical principles of the Association.

PRINCIPLE 4

Physical therapists maintain and promote high standards for physical therapy practice, education, and research.

4.1 Continued Education

   A. Physical therapists shall participate in educational activities that
   enhance their basic knowledge and provide new knowledge.

   B. Whenever physical therapists provide continuing education, they shall
   ensure that course content, objectives, and responsibilities of the
   instructional faculty are accurately reflected in the promotion of the
   course.

4.2 Review and Self-Assessment 

   A. Physical therapists shall provide for utilization review of their
   services.

   B. Physical therapists shall demonstrate their commitment to quality
   assurance by peer review and self-assessment.

4.3 Research

   A. Physical therapists shall support research activities that contribute
   knowledge for improved patient care.

   B. Physical therapists engaged in research shall ensure:

      1. the consent of subjects;

      2. confidentiality of the data on individual subjects and the personal
      identities of the subjects;

      3. well-being of all subjects in compliance with facility regulations
      and laws of the jurisdiction in which the research is conducted;

      4. the absence of fraud and plagiarism;

      5. full disclosure of support received;

      6. appropriate acknowledgment of individuals making a contribution to
      the research;

      7. that animal subjects used in research are treated humanely and in
      compliance with facility regulations and laws of the jurisdiction in
      which the research experimentation is conducted.

   C. Physical therapists shall report to appropriate authorities any acts in
   the conduct or presentation of research that appear unethical or illegal.

4.4 Education

   A. Physical therapists shall support high-quality education in academic and
   clinical settings.

   B. Physical therapists functioning in the educational role are responsible
   to the students, the academic institutions, and the clinical settings for
   promoting ethical conduct in educational activities. Whenever possible, the
   educator shall ensure:

      1. the rights of students in the academic and clinical setting;

      2. appropriate confidentiality of personal information;

      3. professional conduct toward the student during the academic and
      clinical educational processes;

      4. assignment to clinical settings prepared to give the student a
      learning experience.

   C. Clinical educators are responsible for reporting to the academic program
   student conduct that appears to be unethical or illegal.

PRINCIPLE 5

Physical therapists seek remuneration for their services that is deserved and reasonable.

5.1 Fiscally Sound Remuneration

   A. Physical therapists shall never place their own financial interest above
   the welfare of individuals under their care.

   B. Fees for physical therapy services should be reasonable for the service
   performed, considering the setting in which it is provided, practice costs
   in the geographic area, judgment of other organizations, and other relevant
   factors.

   C. Physical therapists should attempt to ensure that providers, agencies,
   or other employers adopt physical therapy fee schedules that are reasonable
   and that encourage access to necessary services.

5.2 Business Practices/Fee Arrangements

   A. Physical therapists shall not:

      1. directly or indirectly request, receive, or participate in the
      dividing, transferring, assigning, or rebating of an unearned fee.

      2. profit by means of a credit or other valuable consideration, such as
      an unearned commission, discount, or gratuity in connection with
      furnishing of physical therapy services.

   B. Unless laws impose restrictions to the contrary, physical therapists who
   provide physical therapy services in a business entity may pool fees and
   moneys received. Physical therapists may divide or apportion these fees and
   moneys in accordance with the business agreement.

   C. Physical therapists may enter into agreements with organizations to
   provide physical therapy services if such agreements do not violate the
   ethical principles of the Association.

5.3 Endorsement of Equipment or Services

   A. Physical therapists shall not use influence upon individuals under their
   care or their families for utilization of equipment or services based upon
   the direct or indirect financial interest of the physical therapist in such
   equipment or services. Realizing that these individuals will normally rely
   on the physical therapists' advice, their best interest must always be
   maintained as well as their right of free choice relating to the use of any
   equipment or service. While it cannot be considered unethical for physical
   therapists to own or have a financial interest in equipment companies or
   services, they must act in accordance with law and make full disclosure of
   their interest whenever such companies or services become the source of
   equipment or services for individuals under their care.

   B. Physical therapists may be remunerated for endorsement or advertisement
   of equipment or services to the lay public, physical therapists, or other
   health professionals, provided they disclose any financial interest in the
   production, sale, or distribution of said equipment or services.

   C. In endorsing or advertising equipment or services, physical therapists
   shall use sound professional judgment and shall not give the appearance of
   Association endorsement.

5.4 Gifts and Other Considerations

   A. Physical therapists shall not accept or offer gifts or other
   considerations with obligatory conditions attached.

   B. Physical therapists shall not accept or offer gifts or other
   considerations that affect or give an objective appearance of affecting
   their professional judgment.

PRINCIPLE 6

Physical therapists provide accurate information to the consumer about the profession and about those services they provide.

6.1 Information About the Profession

Physical therapists shall endeavor to educate the public to an awareness of the physical therapy profession through such means as publication of articles and participation in seminars, lectures, and civic programs.

6.2 Information About Services

   A. Information given to the public shall emphasize that individual problems
   cannot be treated without individualized evaluation and plans/programs of
   care.

   B. Physical therapists may advertise their services to the public.

   C. Physical therapists shall not use, or participate in the use of, any
   form of communication containing a false, plagiarized, fraudulent,
   misleading, deceptive, unfair, or sensational statement or claim.

   D. A paid advertisement shall be identified as such unless it is apparent
   from the context that it is a paid advertisement.

PRINCIPLE 7

Physical therapists accept the responsibility to protect the public and the profession from unethical, incompetent, or illegal acts.

7.1 Consumer Protection

   A. Physical therapists shall report any conduct that appears to be
   unethical, incompetent, or illegal.

   B. Physical therapists may not participate in any arrangements in which
   patients are exploited due to the referring sources enhancing their
   personal incomes as a result of referring for, prescribing, or recommending
   physical therapy.

   C. Physical therapists shall be obligated to safeguard the public from
   underutilization or overutilization of physical therapy services.

7.2 Disclosure

The physical therapist shall disclose to the patient if the referring practitioner derives compensation from the provision of physical therapy. The physical therapist shall ensure that the individual has freedom of choice in selecting a provider of physical therapy.

PRINCIPLE 8

Physical therapists participate in efforts to address the health needs of the public.

8.1 Pro Bono Service

Physical therapists should render pro bono publico (reduced or no fee) services to patients lacking the ability to pay for services, as each physical therapist's practice permits.

Issued by Judicial Committee, APTA, October 1981 Last Amended September 1997