Beauchamp Childress Principlism Tara Stith Sarah Talbert Amanda

Beauchamp & Childress: Principlism Tara Stith, Sarah Talbert, Amanda Stertzbach, Jessica Vogt, Sam Ventura, John Volmer, Billy Vance

Review of the 4 Principles ● Autonomy: Keeping them as independent as possible for as long as possible ● Justice: Fairness, what is deserved, entitlement to that person ● Nonmaleficence: Not causing harm intentionally, based on negligence ● Beneficence: Moral obligation to help others

The Case of Drs. Jones and Smith -Two patients reported the same insurance and same impairment to two different doctors -The physical therapists handling treatment approached each doctor to request three more treatments for each patient -Dr. Jones called the insurance company and was approved for three more sessions; Dr. Smith refused to call and discharged his patient -At an ethics committee meeting, a PT questioned the morality of the issue

Justice Is it fair that the one patient got Dr. Jones and the other patient got Dr. Smith? Each patient deserves the same care, the best care possible. Because Dr. Smith did not reach out to the insurance company for his patient, that patient did not receive the same care as the other patient with the exact same insurance and impairment.

Beneficence Is it Dr. Smith’s moral obligation to spend the time to advocate for this patient? Healthcare providers have a moral obligation to do what is best for their patients. Dr. Smith ignored his obligation by refusing to call the insurance company for extra visits.

Nonmaleficence (not causing harm intentionally, based on negligence) Is Dr. Smith causing harm to his patient by failing to advocate for additional days of therapy? Dr. Smith could be causing potential harm to this patient by not giving them an opportunity to continue in the progression of their recovery.

RIPS Model Realm Individual: concerns doctor, therapist, and patient Individual Process Therapist (from rehab center’s ethics committee): moral sensitivity recognized Dr. Smith’s patient was not treated equally Situation Moral distress: Therapist knows patient wasn’t treated fairly but therapist didn’t have the power to give the patient 3 more days Moral Silence: Therapist could have pushed doctor to contact insurance to get 3 extra days

APTA Code of Ethics 3 A. Physical therapists shall demonstrate independent and objective professional judgment in the patient’s/client’s best interest in all practice settings. 3 C. Physical therapists shall make judgments within their scope of practice and level of expertise and shall communicate with, collaborate with, or refer to peers or other health care professionals when necessary

Consensus Dr. Smith was not morally guided in his decision. If lack of compliance with home exercise was an issue, it would be more beneficial for the patient to continue their stay to ensure maximum functional independence.

Limitations of Principlism Serves as a framework for thinking about ethical dilemmas rather than resolving the issues directly Subjective nature allows individual beliefs to dictate ethical framework Principlism is an individualized process Can't be culturally generalized

Other Theorists’ Thoughts Kant: They should both be treated the same, whether they either get further treatment or not Mills: Both should receive treatment, greatest good for greatest number of people Aristotle: can make own decision as long as it is justified, physician should have called for PT due to no justification other than not having time John Locke & Adam Smith: have contract to perform what is best for patient, Doctor should try to get PT for patient

References http: //www. apta. org/uploaded. Files/APTAorg/About_Us/Policies/Ethics/Codeof. Ethi cs. pdf#search=%22 code of ethics%22 https: //www. apta. org/uploaded. Files/APTAorg/Practice_and_Patient_Care/Ethics/T ools/RIPS_Decision. Making. pdf Principlism by Beauchamp and Childress, Chapter 6, Closed Readings

Questions? ?