This Guide for Professional Conduct (Guide) is intended to serve physical therapists in interpreting the Code of Ethics (Code) of the American Physical Therapy Association (Association), in matters of professional conduct. The Guide provides guidelines by which physical therapists may determine the propriety of their conduct. It is also intended to guide the professional development of physical therapist students. The Code and the Guide apply to all physical therapists. These guidelines are subject to change 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 Ethics and Judicial Committee of the Association.
Interpreting Ethical Principles
The interpretations expressed in this Guide reflect the opinions, decisions, and advice of the Ethics and Judicial Committee. These interpretations are intended to assist a physical therapist in applying general ethical principles to specific situations. They should not be considered inclusive of all situations that could evolve.
A physical therapist shall respect the rights and dignity of all individuals and shall provide compassionate care.
1.1 Attitudes of a Physical Therapist
A. A physical therapist shall recognize, respect, and respond to individual and cultural differences with compassion and sensitivity.
B. A physical therapist shall be guided at all times by concern for the physical, psychological, and socioeconomic welfare of patients/clients.
C. A physical therapist shall not harass, abuse, or discriminate against others.
A physical therapist shall act in a trustworthy manner towards patients/clients, and in all other aspects of physical therapy practice.
2.1 Patient/Physical Therapist Relationship
A. A physical therapist shall place the patient/clientâ€™s interest(s) above those of the physical therapist. Working in the patient/clientâ€™s best interest requires knowledge of the patient/clientâ€™s needs from the patient/clientâ€™s perspective. Patients/clients often come to the physical therapist in a vulnerable state and normally will rely on the physical therapistâ€™s advice, which they perceive to be based on superior knowledge, skill, and experience. The trustworthy physical therapist acts to ameliorate the patientâ€™s/clientâ€™s vulnerability, not to exploit it.
B. A physical therapist shall not exploit any aspect of the physical therapist/patient relationship.
C. A physical therapist shall not engage in any sexual relationship or activity, whether consensual or nonconsensual, with any patient while a physical therapist/patient relationship exists. Termination of the physical therapist/patient relationship does not eliminate the possibility that a sexual or intimate relationship may exploit the vulnerability of the former patient/client.
D. A physical therapist shall encourage an open and collaborative dialogue with the patient/client.
E. In the event the physical therapist or patient terminates the physical therapist/patient relationship while the patient continues to need physical therapy services, the physical therapist should take steps to transfer the care of the patient to another provider.
A physical therapist has an obligation to provide accurate and truthful information. A physical therapist shall not make statements that he/she knows or should know are false, deceptive, fraudulent, or misleading. See Section 8.2.C and D.
2.3 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 patientâ€™s care without the prior consent of the patient, subject to applicable law.
B. Information derived from peer review shall be held confidential by the reviewer unless the physical therapist who was reviewed consents to the release of the information.
C. A physical therapist may disclose information to appropriate authorities when it is necessary to protect the welfare of an individual or the community or when required by law. Such disclosure shall be in accordance with applicable law.
2.4 Patient Autonomy and Consent
A. A physical therapist shall respect the patientâ€™s/clientâ€™s right to make decisions regarding the recommended plan of care, including consent, modification, or refusal.
B. A physical therapist shall communicate to the patient/client the findings of his/her examination, evaluation, diagnosis, and prognosis.
C. A physical therapist shall collaborate with the patient/client to establish the goals of treatment and the plan of care.
D. A physical therapist shall use sound professional judgment in informing the patient/client of any substantial risks of the recommended examination and intervention.
E. A physical therapist shall not restrict patientsâ€™ freedom to select their provider of physical therapy.
A physical therapist shall comply with laws and regulations governing physical therapy and shall strive to effect changes that benefit patients/clients.
3.1 Professional Practice
A physical therapist shall comply with laws governing the qualifications, functions, and duties of a physical therapist.
3.2 Just Laws and Regulations
A physical therapist shall advocate the adoption of laws, regulations, and policies by providers, employers, third party payers, legislatures, and regulatory agencies to provide and improve access to necessary health care services for all individuals.
3.3 Unjust Laws and Regulations
A physical therapist shall endeavor to change unjust laws, regulations, and policies that govern the practice of physical therapy. See Section 10.2.
A physical therapist shall exercise sound professional judgment.
4.1 Professional Responsibility
A. A physical therapist shall make professional judgments that are in the patient/clientâ€™s best interests.
B. Regardless of practice setting, a physical therapist has primary responsibility for the physical therapy care of a patient and shall make independent judgments regarding that care consistent with accepted professional standards. See Sections 2.4 and 6.1.
C. A physical therapist shall not provide physical therapy services to a patient/client while his/her ability to do so safely is impaired.
D. A physical therapist shall exercise sound professional judgment based upon his/her knowledge, skill, education, training, and experience.
E. Upon accepting a patient/client for physical therapy services, a physical therapist shall be responsible for: the examination, evaluation, and diagnosis of that individual; the prognosis and intervention; re-examination and modification of the plan of care; and the maintenance of adequate records, including progress reports. A physical therapist shall establish the plan of care and shall provide and/or supervise and direct the appropriate interventions. See Section 2.4.
F. If the diagnostic process reveals findings that are outside the scope of the physical therapistâ€™s knowledge, experience, or expertise, the physical therapist shall so inform the patient/client and refer to an appropriate practitioner.
G. When the patient has been referred from another practitioner, the physical therapist shall communicate pertinent findings and/or information to the referring practitioner.
H. A physical therapist shall determine when a patient/client will no longer benefit from physical therapy services. See Section 7.1.D.
4.2 Direction and Supervision
A. The supervising physical therapist has primary responsibility for the physical therapy care rendered to a patient/client.
B. A physical therapist shall not delegate to a less qualified person any activity that requires the professional skill, knowledge, and judgment of the physical therapist.
4.3 Practice Arrangements
A. Participation in a business, partnership, corporation, or other entity does not exempt physical therapists, whether employers, partners, or stockholders, either individually or collectively, from the obligation to promote, maintain and comply with the ethical principles of the Association.
B. A physical therapist shall advise his/her employer(s) of any employer practice that causes a physical therapist to be in conflict with the ethical principles of the Association. A physical therapist shall seek to eliminate aspects of his/her employment that are in conflict with the ethical principles of the Association.
4.4 Gifts and Other Consideration(s)
A. A physical therapist shall not invite, accept, or offer gifts, monetary incentives, or other considerations that affect or give an appearance of affecting his/her professional judgment.
B. A physical therapist shall not offer or accept kickbacks in exchange for patient referrals. See Sections 7.1.F and G and 9.1.D.
A physical therapist shall achieve and maintain professional competence.
5.1 Scope of Competence
A physical therapist shall practice within the scope of his/her competence and commensurate with his/her level of education, training and experience.
A physical therapist has a lifelong professional responsibility for maintaining competence through on-going self-assessment, education, and enhancement of knowledge and skills.
5.3 Professional Development
A physical therapist shall participate in educational activities that enhance his/her basic knowledge and skills. See Section 6.1.
A physical therapist shall maintain and promote high standards for physical therapy practice, education and research.
6.1 Professional Standards
A physical therapistâ€™s practice shall be consistent with accepted professional standards. A physical therapist shall continuously engage in assessment activities to determine compliance with these standards.
A. A physical therapist shall achieve and maintain professional competence. See Section 5.
B. A physical therapist shall demonstrate his/her commitment to quality improvement by engaging in peer and utilization review and other self-assessment activities.
6.3 Professional Education
A. A physical therapist shall support high-quality education in academic and clinical settings.
B. A physical therapist participating in the educational process is responsible to the students, the academic institutions, and the clinical settings for promoting ethical conduct. A physical therapist shall model ethical behavior and provide the student with information about the Code of Ethics, opportunities to discuss ethical conflicts, and procedures for reporting unresolved ethical conflicts. See Section 9.
6.4 Continuing Education
A. A physical therapist providing continuing education must be competent in the content area.
B. When a physical therapist provides continuing education, he/she shall ensure that course content, objectives, faculty credentials, and responsibilities of the instructional staff are accurately stated in the promotional and instructional course materials.
C. A physical therapist shall evaluate the efficacy and effectiveness of information and techniques presented in continuing education programs before integrating them into his or her practice.
A. A physical therapist participating in research shall abide by ethical standards governing protection of human subjects and dissemination of results.
B. A physical therapist shall support research activities that contribute knowledge for improved patient care.
C. A physical therapist shall report to appropriate authorities any acts in the conduct or presentation of research that appear unethical or illegal. See Section 9.
A physical therapist shall seek only such remuneration as is deserved and reasonable for physical therapy services.
7.1 Business and Employment Practices
A. A physical therapistâ€™s business/employment practices shall be consistent with the ethical principles of the Association.
B. A physical therapist shall never place her/his own financial interest above the welfare of individuals under his/her care.
C. A physical therapist shall recognize that third-party payer contracts may limit, in one form or another, the provision of physical therapy services. Third-party limitations do not absolve the physical therapist from making sound professional judgments that are in the patientâ€™s best interest. A physical therapist shall avoid underutilization of physical therapy services.
D. When a physical therapistâ€™s judgment is that a patient will receive negligible benefit from physical therapy services, the physical therapist shall not provide or continue to provide such services if the primary reason for doing so is to further the financial self-interest of the physical therapist or his/her employer. A physical therapist shall avoid overutilization of physical therapy services. See Section 4.1.H.
E. 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.
F. A physical therapist shall not directly or indirectly request, receive, or participate in the dividing, transferring, assigning, or rebating of an unearned fee. See Sections 4.4.A and B.
G. A physical therapist shall not profit by means of a credit or other valuable consideration, such as an unearned commission, discount, or gratuity, in connection with the furnishing of physical therapy services. See Sections 4.4.A and B.
H. Unless laws impose restrictions to the contrary, physical therapists who provide physical therapy services within a business entity may pool fees and monies received. Physical therapists may divide or apportion these fees and monies in accordance with the business agreement.
I. A physical therapist may enter into agreements with organizations to provide physical therapy services if such agreements do not violate the ethical principles of the Association or applicable laws.
7.2 Endorsement of Products or Services
A. A physical therapist shall not exert influence on individuals under his/her care or their families to use products or services based on the direct or indirect financial interest of the physical therapist in such products or services. Realizing that these individuals will normally rely on the physical therapistâ€™s advice, their best interest must always be maintained, as must their right of free choice relating to the use of any product or service. Although it cannot be considered unethical for physical therapists to own or have a financial interest in the production, sale, or distribution of products/services, they must act in accordance with law and make full disclosure of their interest whenever individuals under their care use such products/services.
B. A physical therapist may receive remuneration for endorsement or advertisement of products or services to the public, physical therapists, or other health professionals provided he/she discloses any financial interest in the production, sale, or distribution of said products or services.
C. When endorsing or advertising products or services, a physical therapist shall use sound professional judgment and shall not give the appearance of Association endorsement unless the Association has formally endorsed the products or services.
A physical therapist shall disclose to the patient if the referring practitioner derives compensation from the provision of physical therapy.
A physical therapist shall provide and make available accurate and relevant information to patients/clients about their care and to the public about physical therapy services.
8.1 Accurate and Relevant Information to the Patient
A. A physical therapist shall provide the patient/client accurate and relevant information about his/her condition and plan of care. See Section 2.4.
B. Upon the request of the patient, the physical therapist shall provide, or make available, the medical record to the patient or a patient-designated third party.
C. A physical therapist shall inform patients of any known financial limitations that may affect their care.
D. A physical therapist shall inform the patient when, in his/her judgment, the patient will receive negligible benefit from further care. See Section 7.1.C.
8.2 Accurate and Relevant Information to the Public
A. A physical therapist shall inform the public about the societal benefits of the profession and who is qualified to provide physical therapy services.
B. Information given to the public shall emphasize that individual problems cannot be treated without individualized examination and plans/programs of care.
C. A physical therapist may advertise his/her services to the public. See Section 2.2.
D. A physical therapist shall not use, or participate in the use of, any form of communication containing a false, plagiarized, fraudulent, deceptive, unfair, or sensational statement or claim. See Section 2.2.
E. A physical therapist who places a paid advertisement shall identify it as such unless it is apparent from the context that it is a paid advertisement.
A physical therapist shall protect the public and the profession from unethical, incompetent, and illegal acts.
9.1 Consumer Protection
A. A physical therapist shall provide care that is within the scope of practice as defined by the state practice act.
B. A physical therapist shall not engage in any conduct that is unethical, incompetent or illegal.
C. A physical therapist shall report any conduct that appears to be unethical, incompetent, or illegal.
D. A physical therapist may not participate in any arrangements in which patients are exploited due to the referring sourcesâ€™ enhancing their personal incomes as a result of referring for, prescribing, or recommending physical therapy. See Sections 2.1.B, 4, and 7.
A physical therapist shall endeavor to address the health needs of society.
10.1 Pro Bono Service
A physical therapist shall render pro bono publico (reduced or no fee) services to patients lacking the ability to pay for services, as each physical therapistâ€™s practice permits.
10.2 Individual and Community Health
A. A physical therapist shall be aware of the patientâ€™s health-related needs and act in a manner that facilitates meeting those needs.
B. A physical therapist shall endeavor to support activities that benefit the health status of the community. See Section 3.
A physical therapist shall respect the rights, knowledge, and skills of colleagues and other healthcare professionals.
A physical therapist shall seek consultation whenever the welfare of the patient will be safeguarded or advanced by consulting those who have special skills, knowledge, and experience.
11.2 Patient/Provider Relationships
A physical therapist shall not undermine the relationship(s) between his/her patient and other healthcare professionals.
Physical therapists shall not disparage colleagues and other health care professionals. See Section 9 and Section 2.4.A.
Issued by Ethics and Judicial Committee
American Physical Therapy Association
Last Amended January 2004