Includes Amendments – AGM 2001

Physiotherapists are responsible for adhering to and promoting ethical practice. The Code of Ethics for Physiotherapists sets forth the fundamental ethical principles that physiotherapists, and those preparing to enter the profession, should accept to fulfil their obligations to clients, the profession and society. By providing a series of guidelines for ethical practice, this Code helps physiotherapists interpret what constitutes appropriate conduct in situations of uncertainty; it also serves as a basis for reflection and self-evaluation. That said, the Code can neither alleviate the distress that often accompanies ethical decision-making, nor act as a substitute for the individual practitioner’s commitment to act with integrity.

Keep in mind that the Code is a general guide for ethical practice, and not an encyclopedia of the regulations, standards and policies that govern the profession. No attempt has been made to indicate areas where there is overlap between legal and ethical requirements or to cross-reference ethical principles to corresponding laws, professional standards and guidelines. Because the primary objective has been to address broad ethical obligations, the onus is on individual physiotherapists to maintain a working knowledge of, and comply with, the legislation and policies in force in the workplaces and jurisdictions in which they practice. It is recognized that circumstances vary; factors such as the individual client, practice setting, resource limitations and so on, must be considered when physiotherapists make practice decisions.

The Code also reflects the profession’s commitment to use its knowledge and expertise to promote, to the extent possible, the welfare of all members of society. For those outside the profession, the Code helps instill confidence in the discipline, and serves as a concrete reminder of the high standards of ethical conduct that have come to be synonymous with the practice of physiotherapy.

Since the text of the Code of Ethics is an almost identical copy to that of the College of Physiotherapists of Ontario, we thank and credit them for their leadership and generosity in sharing their expertise.

The physiotherapist has ethical obligations to the client and the profession, as well as her or his employer(s), colleagues and the agencies with which he or she interacts.

To the profession: The physiotherapist is obligated to uphold the dignity and honour of the profession by practicing in accordance with its standards and values, and by participating in initiatives aimed at improving these standards. The physiotherapist should accept the ethical principles of the College, and refrain from engaging in any activity that would violate the Code of Ethics or bring discredit upon the profession. The physiotherapist should also contribute to the betterment of the profession by supporting associations and institutes engaged in physiotherapy education, research and advocacy.

To the employer: The physiotherapist is obligated to ensure that her or his practice conforms to the rules, regulations and guidelines set out by the College. When there is a discrepancy between the employer’s requirements and those of the College, the onus is on the physiotherapist to ensure that the terms or conditions under which he or she is practicing do not compromise her or his ability to deliver quality care.

The physiotherapist:

1.1 Acts in the best interests of the client, giving the client’s concerns priority.

1.2 Is discouraged from entering physiotherapist-client relationships in which the physiotherapist’s judgment regarding client service could be compromised, e.g., in the treatment of family members.

1.3 Recognizes the power imbalance inherent in all physiotherapist-client relationships and respects professional boundaries.

1.4 Refrains from making remarks or gestures that may be interpreted as sexually demeaning and from engaging in any sexual relationship or activity with the client.

1.5 Refrains from exploiting the physiotherapist-client relationship to enhance her or his own personal income, e.g., by failing to disclose personal financial interests in services recommended to clients.

1.6 Refrains from participating in any arrangement that financially rewards referral sources.

1.7 Stays well-informed of, is guided by, and assists the profession in improving its standards and values.

1.8 Serves the agency/employer fairly and honestly.

9. States explicitly any reservations concerning the standards or values of the agency/employer, and attempts to rectify employment practices that are in conflict with the profession’s ethical principles.
9. When working for non-physiotherapists, assumes responsibility for verifying that such arrangements do not violate the ethical principles of the profession.

The physiotherapist:

1.17 Presents professional qualifications honestly.

1.18 Engages in life-long learning to continually improve practice.

1.19 Demonstrates commitment to continuous quality improvement, e.g., by participating fully in the College’s professional development and competency initiatives.

1.20 Refrains from practicing outside her or his level of competence.

1.21 Refrains from providing services if her or his ability to do so is compromised, e.g., by chemical impairment or emotional distress.

The physiotherapist:

1.22 Recognizes each client’s unique mix of characteristics, including gender, age, ethnic origin, religion, culture, language, sexual orientation, health status and need for physiotherapy services.

1.23 Ensures that the client is addressed and treated respectfully, and that he or she receives attention according to individual need.

1.24 Assists the client in expressing her or his needs.

1.25 Respects the client’s right to make an informed decision when they may be able to choose among available physiotherapists, facilities or services by disclosing fully and honestly all relevant information, e.g., factors, including resources and policies that could influence the client’s choice of publicly funded or private services.

1.26 Recognizes the client’s right to have her or his physical modesty and psychological privacy protected.

1.27 Acts on the client’s behalf, when necessary, encouraging others to respect the client’s rights and dignity.

In general, physiotherapists should facilitate informed decision-making by respecting the client’s right to participate in treatment decisions and to be informed of the potential risks and benefits of treatment options. In cases where, in the physiotherapist’s opinion, truthful disclosure of information could result in harm to the client, the physiotherapist must decide how to be truthful, yet minimize the risk of harm.

The physiotherapist:

1.28 Answers client questions truthfully, objectively and as completely as possible.

1.29 Seeks the assistance of appropriate health care practitioners to answer client questions beyond the scope of physiotherapy practice.

1.30 Provides information required to help clients make informed decisions about physiotherapy services, e.g., the purpose and effect of specific interventions, potential risks, and the anticipated frequency and duration of service.

1.31 When referring the client to another physiotherapist, health practitioner or facility, informs the client of:

(i) the reason(s) for the referral;

(ii) the relative cost of services, if known;

(iii) the information that will be shared with the practitioner;

(iv) any interest or involvement in the referral.

1.32 Provides information in ways that will prevent harm to the client and offers appropriate emotional support or referral to other health professionals, if beyond scope.

1.33 Informs the clients promptly if any errors have occurred during the course of treatment.

The physiotherapist respects the client’s right to make choices about health care, to receive adequate information about the pros and cons of a proposed course of treatment and to accept or refuse such treatment without coercion.

The physiotherapist:

1.34 Respects the client’s right to make decisions about health providers, facilities and services, as resources and policies allow.

1.35 Refrains from coercing the client’s consent or penalizing the client if he or she refuses an intervention prior to, during, or following a treatment.

Physiotherapists are obligated to maintain the privacy of clients’ personal information, and must not disclose such information to anyone without proper client authorization, (including e.g., agreements between clients and Third Party Payers.) While information about the client is often shared among members of the health care team to facilitate quality care, the onus is on the physiotherapist to ensure that any personal or irrelevant information about the client or her or his conduct or affairs remains confidential.

The physiotherapist:

1.36 Maintains the privacy of the clinical record, as well as all information relating to the client’s personal conduct and affairs.

1.37 Discusses the client’s personal information only with her or his permission or as law permits to protect the welfare of the individual or the community.

1.38 Prior to initiating service, explains any foreseeable limitations on preserving the confidentiality of information to the client, e.g., legal obligation to report when an examination is conducted on behalf of a third party.

 

The physiotherapist’s primary goal is restoring, to the extent possible, the client’s health-related quality of life and physical function. To fulfil that goal, the physiotherapist must, at all times, be guided by concern for the client’s psychological and physical welfare.

This obligation should extend to helping the client understand and comply with her or his treatment instructions, and to ensuring that the client’s concerns with respect to the decision to withdraw treatment when it is no longer necessary or effective are addressed in a supportive and compassionate manner.

The physiotherapist:

1.39 Maintains ongoing and constructive communication with the client and, where appropriate, with the client’s significant others.

1.40 Within the constraints of the practice setting, strives to honour the client’s freedom of choice in selecting service providers, and facilities referral to other physiotherapists or health professionals at client’s request.

1.41 Within the constraints of the practice setting, may withdraw services after providing the client with reasonable advance notice and/or taking steps to transfer the client’s care to another physiotherapist.

1.42 Ensures that all components of physiotherapy care comply with the profession’s Standards of Practice and College guidelines.

1.43 Within the health care system, identifies issues regarding the client’s well-being which may need to be addressed by those responsible for providing service to the client.

1.44 Refrains from assigning to non-physiotherapists any activity that requires the unique judgement, skill and knowledge of a physiotherapist.

 

The physiotherapist is committed to promoting the well-being of all clients. Within the constraints of the practice setting, the physiotherapist uses professional judgment to fairly apply priorities for client intake, allocation of time, and criteria for discharge.

The physiotherapist:

1.45 Understands and complies with policies guiding distribution of resources in the workplace and helps improve such policies when necessary.

1.46 Advocates on behalf of the client whose needs are not met within the established practices, policies and resources of the practice setting.

1.47 Follows a personal ethical framework for use in making decisions about fairness to clients.

Collegiality

Improving the client’s well-being may require the contribution of many health care providers. Collaboration and communication are essential to ensuring quality service.

The physiotherapist:

1.48 Assists other physiotherapists and health professionals as requested or needed.

1.49 Respects the members of the health care team and recognizes their expertise.

1.50 Shares information with team members, provided client consent is obtained where required.

1.51 Collaborates with team members in the planning and evaluation of client care.

1.52 Intervenes, as needed, if any member of the health care team appears to be providing service to the client in an incompetent, incapacitated or unethical manner.

1.53 Refrains from providing care in cases where a second practitioner is treating the client and:

(i) the services constitute a duplication;

(ii) the second practitioner is known to have conflicting treatment philosophies or client care objectives;

The physiotherapist’s commitment to act with integrity is fundamental to the delivery of professional service. Challenges can arise as a result of many situations, including conflict between an individual’s conscience and a client’s request, or between the physiotherapist’s standard of service and that of the employer or agency.

1.54 Reviews options for action when faced with difficult decisions, consulting colleagues as needed.

1.55 Reviews, and observes in practice, her or his personal ethical principles, ensuring that they remain consistent with the expectations for ethical conduct established by the College.

1.56 Refrains from providing service when doing so would violate her or his fundamental ethical values, and provides a referral to a practitioner who will deliver the necessary care.

1.57 Makes known possible conflicts between personal values and those of employers, agencies or third-party payers and, where possible, attempts to resolve such differences.

Quality education in both clinical and academic settings is essential to the effective practice of physiotherapy. The profession is responsible for preparing educators, designing suitable curricula, and selecting, evaluating and supervising students. The physiotherapist-educator should use the Code of Ethics as a teaching tool and exemplify its principles by serving as a role model for ethical conduct.

The profession:

2.1 Helps ensure physiotherapy students attain a high standard of client care by encouraging its members to participate, wherever possible, in educational and mentoring opportunities, e.g., student placements and supervised practice arrangements.

2.2 Promotes ethical conduct in all aspects of educational activity by, at a minimum requiring its members to:

(i) respect the rights of individual students and interact with them in a professional manner, both in clinical and academic settings;

(ii) demonstrate ethical practice in all aspects of clinical education; and

(ii) report to the appropriate authorities illegal or unethical conduct among administrators, educators or students.

2.3 Advocates the study and observances of the profession’s ethical values in undergraduate and continuing education for physiotherapists.

Ongoing research into the science, teaching and practice of physiotherapy is necessary to advance the profession. Aspects of research emphasizing ethical issues and the importance of evidence-based practice should be included in the curricula, and used to demonstrate both accountability for the delivery of services to individual clients and concern for the welfare of society as a whole.

The profession:

2.4 Promotes physiotherapy research that contributes to improved client outcomes and supports the incorporation of resulting evidence into practice.

2.5 Teaches and observes the principles of research ethics and prevailing ethical standards.

2.6 Educates physiotherapists on standard research ethics review processes.

The profession represents its values to the public both formally, through official activity with various groups, and informally, through physiotherapists in practice.

The profession:

3.1 Participates in collaborative activities where its expertise can be helpful.

3.2 Accepts and creates opportunities to inform the public about its values, positions and activities.

As part of its commitment to promote the health and welfare of all members of society, physiotherapists should participate in community initiatives, particularly when these are aimed at ensuring that all citizens have reasonable access to physiotherapy and other health care services. Advocacy for improved access, or activities to heighten awareness of the importance of timely intervention and preventive health care, should be undertaken publicly and, where appropriate, in cooperation with other health and community groups.

The profession:

3.3 Advocates for adequate availability of and access to physiotherapy services.

3.7 Collaborates with other health care groups in public education activities.

Many physiotherapists are members of organized labor groups. Any job action taken by these groups may raise concerns about the profession’s commitment to the well-being of its clients.

The profession:

3.10 Respects the ethical and legal right of individual physiotherapists to join labour groups.

3.11 Requires that client safety be maintained during any job action.

3.12 Endorses the right of individual physiotherapists to decide whether to participate in job action.

3.13 Insists that the public is informed in advance of any job action and collective arrangements are made for the safety of clients while such action is in effect.

Physiotherapists are expected to demonstrate sound moral judgment and personal integrity, and maintain respect for the law in both their personal and professional endeavors. Because the profession, through the College, has the legal power to investigate complaints, order remediation and discipline members found guilty of misconduct or incompetence, the physiotherapist who fails to comply with the laws and regulations governing the practice of physiotherapy may face significant professional consequences, including suspension or revocation of her or his certificate of registration. Members are expected to use the Code of Ethics as a guideline to determine the propriety of their professional conduct.

September 2000 & October 2001