Physical Therapy Ethics.

Gabard DL, Martin MW. Philadelphia, PA 19103, FA Davis Co, 2003, paperback, 272 pp, ISBN: 0-8036-1046-7, $32.95.

The authors begin their book with the statement "Ethics is the heart of professionalism" and hold to this theme throughout. As the title implies, this book is clearly directed to physical therapists and physical therapist assistants. The authors' frequent references to the American Physical Therapy Association's Code of Ethics and Guide for Professional Conduct (which are included as appendixes) and to other writers on medical ethics support this focus.

The format of the book is consistent and well organized. Each chapter begins with a provocative question that addresses a key value. This key value, such as integrity in chapter 8, often refers to a both a responsibility and a virtue. Each chapter then proceeds with a list of keywords, case studies, and clusters of discussions on topics related to the key value. Clearly outlined headings and subtitles add to the clarity. Each chapter concludes with discussion questions and references to the work of classical theorists as well as contemporary texts and essays from reputable sources and peer-reviewed publications.

The content of the book spans the spectrum of ethical topics. Chapters 1 and 2 address professionalism, judgment, and moral reasoning, thereby laying a foundation for the following chapters by referring to the major contemporary ethical theories. This might be tough reading for some physical therapist students who feel more comfortable with concrete concepts and answers. The authors, however, bring these theories to life by using clear language, by focusing on applied ethics, and by grounding discussions in specific examples in physical therapist practice.

A useful section in chapter 1 presents some steps that physical therapists can take when faced with an ethical dilemma. Acknowledging that there often is no clear "correct" answer the authors encourage the reader to use these tools to address the problem at hand. Not only can these strategies can be employed when analyzing the case studies and discussion questions found in the book, they also can be applied in daily practice. Many of the suggestions reach far beyond the resolution of dilemmas by reminding us to use codes, laws, reflective thought, and discussions with colleagues as part of our moral and ethical compass.

Chapters 3, 4, 6, and 7 cover topics that would be expected in an ethics text, including confidentiality, informed consent, abuse and neglect, death and dying, and conflicts of interest. Once again, the case studies related to physical therapy lend a fresh perspective to familiar issues.

Chapter 5 delves into the timely topic of diversity, with discussions of racism, sexism, disabilities, and affirmative action. Chapter 8 broaches some difficult questions on sexual harassment and substance abuse by professionals. The authors stimulate frank dialogue on issues that are often not addressed in an open and honest manner in the health care environment. Access to health care, leadership, and research found out the final 3 chapters in the text.

Volumes have been written about each of the topics discussed in this book, and each topic deserves in-depth discussion. One potential criticism of the book may be that the authors tried to cover too much in a compact text; however, they managed to find the right combination of thoroughness and brevity for the beginning student. Those who desire more can find ample references at the end of each chapter.

The authors have been successful in creating an accessible and relevant ethics text. The challenge will be for physical therapy educators and clinicians to tap this resource and apply the concepts in practice. This text would serve well in an ethics course, and the authors provide some suggestions on how to do so in chapter 1. As the authors imply, however, ethics discussions should not stop at the classroom door. We would do a great service to our profession by weaving these discussions into clinical courses and daily experiences as we move toward the responsibilities and challenges of autonomous practice.

Ann M York, PT, PhD

Des Moines University 

Des Moines, Iowa 

Dr York is Academic Coordinator of Clinical Education and Assistant Professor in the Division of Physical Therapy. She has an extensive background in health care management and human resources and has served as both a Compliance Officer and a HIPAA Privacy Officer.