Constrained Physical Therapist Practice: An Ethical Case Analysis

Participants: Ernest Nalette, PT, EdD, Associate Professor, Department of Physical Therapy, Ithaca College, Rochester, New York; Gail M. Jensen, PT, PhD, FAPTA, Dean of the Graduate School, Associate Vice President of Academic Affairs, Professor of Physical Therapy, and Faculty Associate, Center for Health Policy and Ethics, Creighton University, Omaha, Nebraska; and Beth A. Smith, PT, DPT, PhD, Postdoctoral Fellow, Balance Disorders Laboratory, Departments of Neurology and Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon. Moderator: Diane U. Jette, PT, DSc, Editorial Board member, PTJ.

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• Discussion Podcast - Physical therapists sometimes have hard decisions to make in today's health care systems. In "Constrained Physical Therapist Practice: An Ethical Case Analysis of Recommending Discharge Placement From the Acute Care Setting," Nalette describes the moral dilemma of Mary, a physical therapist in an acute care hospital where resource constraints on the provision of physical therapy care cause her to provide less care than one of her patients needs. Jensen sees Mary's dilemma as a case of allocating or rationing a scarce resource—physical therapy—in an equitable manner. Mary, says Jensen, "is actually being forced into a rationing decision." Nalette observes that rationing "has become common practice," resulting in the reduced provision of service to patients, particularly to racial and ethnic minorities and those who are poor. Does the model of physical therapist practice in acute care actually inflict this lack of fairness? If the acute care setting routinely forces physical therapists into these types of moral dilemmas, what is the role of the physical therapist in the acute care setting? What do YOU think? Submit comments at http://ptjournal.apta.org/cgi/eletter-submit/90/6/939, comment on Twitter (@PTJournal), or e-mail ptjourn{at}apta.org.

  Quick Grabs:

  Gail Jensen: "We have some responsibility as a moral community. What is our role? What is the profession's role in acute care?"
  
  Beth Smith: "(One) way to go (is) that physical therapy treatment doesn't happen in acute care. That's a rationing decision that we may make as a profession."
  
  Ernie Nalette: "If it (the situation) hits home personally, people seem much more willing to step up and take a risk to change the status quo."

  Running time: 21:06 (14.6 MB). Posted 7/29/2010.

  References Cited in the Discussion

  Smith BA, Fields CJ, Fernandez N. Physical therapists make accurate and appropriate discharge recommendations for patients who are acutely ill. Phys Ther. 2010;90:693-703.

  Delany CM, Edwards I, Jensen GM, Skinner E. Closing the gap between ethics knowledge and practice through active engagement: an applied model of physical therapy ethics. Phys Ther. 2010;90:1068-1078.

  2007 Rothstein Debate: "Should Physical Therapists Practice in Acute Care Settings?" PT 2007: American Physical Therapy Association Annual Conference and Exposition. June 29, 2007; Denver, Colorado. Summary available at: http://www.apta.org/AM/Template.cfm?Section=Annual_Conference1&CONTENTID=40785&TEMPLATE=/CM/ContentDisplay.cfm

  Nash RJ. "Real World" Ethics: Frameworks for Educators and Human Service Professionals. 2nd ed. New York, NY: Teachers College Press; 2002.

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