The Ethical Dilemma

Jamie, PT, owns JKL private clinic and is working with Fred as he prepares for hip surgery next week. Fred is not happy he needs the surgery and during a session admits to Jamie that he’s depressed, drinking heavily and smoking pot. Jamie asks Fred if his surgeon or family doctor know how he’s feeling and how much he’s drinking. Fred says, “No and don’t tell them—I don’t want to have my surgery cancelled after all this!”

Jamie thinks the surgical and post-op team should know about Fred’s state of mind and alcohol abuse, but he’s not sure he’s allowed to tell them, and now Fred has specifically told him not to. Jamie is worried that if he doesn’t tell the health team Fred could be at risk during his surgery and post-op, and thinks he should do something. 

The Requirement

A physiotherapist has a legal and professional obligation to maintain patient confidentiality under the Personal Health Information Protection Act, 2004 (PHIPA). Fred has requested confidentiality and did not consent to the information being shared with other health care providers. Maintaining confidentiality is fundamental to providing the highest standard of care as patients who understand their information will remain confidential are more likely to share complete and accurate health information. Under certain circumstances, PTs may disclose personal health information about a patient if the PT believes that sharing information is necessary to reduce a significant risk of serious harm to the patient. 

What Hapened?

Jamie contacted a bioethicist and an anaesthetist for guidance and received two different opinions. Jamie still didn’t know what to do. He reviewed the privacy legislation (PHIPA) and the Code of Ethics and reflected on his own personal values and Fred’s right to autonomy.  Jamie decided that Fred faced a significant risk of harm and even death if the information was not shared so he did contact the surgeon.

The Consequences

Ethical dilemmas often have more than one appropriate course of action. Another individual might have determined that Fred understood the significant risks of not disclosing the information and chose to stay silent. PTs must use their professional judgment and come to the best possible resolution with the patient’s well-being in mind. When faced with ethical dilemmas, we encourage PTs to discuss the matter with a colleague, supervisor or mentor or contact the College Practice Advisor at practiceadvice@collegept.org or 1-800-583-5885 ext. 241.

What would you do?

Send communications@collegept.org your thoughts on this ethical dilemma and we’ll continue the discussion.