Code of Ethical Conduct

This Code applies to registered physiotherapists in Ontario.

Purpose

A code of ethical conduct sets out the ethical principles governing the conduct of members of the physiotherapy profession in Ontario. It is a moral anchor that assures patients¹, the public, and other health-care providers that members of the profession strive for the highest standards of ethical conduct. A code must reflect the societal ethics of the time, as well as the value systems and moral principles of the physiotherapy profession. The Code of Ethical Conduct applies to all physiotherapists in all contexts of practice and through all stages of their careers. It must always be used in conjunction with relevant federal and provincial legislation and with regulations, policies, procedures, and standards that regulate professional practice.

How to Use the Code of Ethical Conduct

The Code does not tell practitioners exactly how to act in every situation. Rather, it provides a benchmark against which to measure ethical decisions in everyday practice and in complex situations. In every situation, however, it is the duty of each member of the profession to act in an ethically responsible manner, using the principles of the Code to guide ethical conduct. As ethical decision-making is often an interdisciplinary issue, each practitioner is encouraged to seek additional advice or consultation when ethical decisions are unclear. Members of the physiotherapy profession should be able to articulate their rationale for all ethical decisions and should take responsibility for their decision-making and actions.

Ethical Principles and Core Professional Values

Ethical principles form the foundation of ethical conduct and provide guidance along the pathway to ethical decision-making. While there are several approaches to ethical decision-making this document uses the classical ethical principles described below as a basic guide to ethical conduct. Emphasis is on the pursuit of excellence in all professional activities, as well as the ability to act with integrity, accountability, and good judgement in the best interests of the patient, the public, the individual (self), and the profession.

• Respect for Autonomy states that people should be allowed to make decisions that apply to their lives and to have control over their lives as much as possible. Autonomy requires a physiotherapist to respect a patient’s freedom to decide for themselves and includes obtaining informed consent.
• Beneficence guides the practitioner to do what is good with respect to the welfare of the patient. In physiotherapy practice, the physiotherapist should provide benefit to the patient’s health.
• Least Harm deals with situations in which none of the choices available are judged to be the best. In this case, a practitioner should choose to do the least harm possible and to do harm to the fewest people. For physiotherapists, this may mean recommending an intervention that is the best of two alternatives, even though both alternatives may have negative side effects.
• Justice requires that the actions chosen are objective and equitable to those involved. An ethical decision that relates to justice has a consistent logical basis that supports the decision. For physiotherapists, justice relates to treating people equitably and to allocating resources fairly between patients.

In addition to the ethical principles, core professional values² help to support the ethical conduct of members of the profession. These are the values that guide the decisions physiotherapists make and inform their behaviours as individuals and as members of a profession. The core professional values include accountability, advocacy, altruism, compassion, equity, excellence, integrity, patient-centredness³, respect, and social responsibility. The Core Professional Values with associated behaviours can be found here.

The ethical responsibilities below are described under three headings: those that apply to the patient; those that apply to the public; and those that apply to the individual practitioner (self) and the profession.

Throughout the document the core professional values are indicated in parenthesis. Ethical responsibilities are intended to serve as a guide to ethical conduct. No ethical responsibility or core professional value will apply at all times and to all situations, but they should serve as references to guide sound ethical conduct and to help prevent unethical behaviours and choices.

Ethical Responsibilities

A. Responsibilities to the Patient

Members of the physiotherapy profession have an ethical responsibility to:

1. Demonstrate sensitivity toward individual patients, respecting and taking into consideration their unique rights, needs, beliefs, values, culture, goals, and the environmental context. (Patient-centredness, Respect)
2. Act in a respectful manner, and do not refuse care or treatment to any patient on the prohibited grounds of discrimination, as specified in the Ontario Human Rights Code⁴ and the Canadian Human Rights Act⁵, as well as on the grounds of social or health status. (Equity, Respect)
3. Work in partnership with patients to improve, support, and/or sustain their health status and well-being. (Patient-centredness, Compassion, Equity)
4. Maintain professional boundaries that honour and respect the therapeutic relationship with patients. (Accountability, Integrity)
5. Communicate openly, honestly, and respectfully with patients at all times. (Integrity, Respect)
6. Respect the principles of informed consent, including by explaining service options, risks, benefits, potential outcomes, possible consequences of refusing treatment or services, and by avoiding coercion. (Accountability, Patient-centredness, Integrity)
7. Treat patients only when the diagnosis or continuation of the intervention warrants treatment and is not contraindicated. (Accountability, Integrity)
8. Respect and support the autonomy of the patient to participate in the management and decision-making relating to their own health. (Accountability, Integrity)
9. Provide an alternative treatment option through referral to another health-care provider/ physiotherapist, if the therapeutic relationship is compromised. (Accountability, Altruism)
10. Respect the confidentiality, privacy, and security of patient information in all forms of communication. (Accountability, Integrity)
11. Use electronic communication and social media and other forms of digital technology professionally and respectfully, conforming to confidentiality guidelines. (Accountability, Integrity)
12. Practise in a safe, competent, accountable, and responsible manner during the provision of services. (Accountability, Excellence)
13. Take all reasonable steps to prevent harm to patients. Should harm occur, disclose it to the patient and others, as required. (Accountability, Integrity)
14. Take responsibility for the patient care delegated to students and other members of the health-care team. (Accountability)
15. Practise the profession of physiotherapy, according to their own competence and limitations, referring the patient to others, as necessary. (Accountability, Excellence, Integrity)
16. Practise collaboratively with colleagues, other health professionals, and agencies for the benefit of patients. (Advocacy, Patient-centredness)
17. Enhance their expertise through lifelong acquisition and refinement of knowledge, skills, abilities, and professional behaviours. (Accountability, Excellence)
18. Comply with all legislation, guidelines, and regulatory requirements that pertain to the profession of physiotherapy. (Accountability, Integrity)

B. Responsibilities to the Public

Members of the physiotherapy profession have an ethical responsibility to:

19. Conduct and present themselves with integrity and professionalism. (Integrity)
20. Respect diversity and provide care that is both culturally sensitive and appropriate. (Patient-centredness, Equity, Respect, Social Responsibility)
21. Advocate within their capacity and context to address patients’ needs and the broad determinants of health and to improve the standards of health care. (Advocacy, Equity, Social Responsibility)
22. Work effectively within the health-care system and manage resources responsibly. (Accountability, Integrity)
23. Act transparently and with integrity in all professional and business practices, including fees and billing, advertising of professional services, and real and/or perceived conflicts of interest. (Accountability, Integrity)
24. Assess the quality and impact of their services regularly. (Accountability, Excellence)
25. Be professionally and morally responsible for addressing incompetent, unsafe, illegal, or unethical practice of any health-care provider and be legally responsible for reporting to the appropriate authority/authorities conduct that puts the patient at risk. (Accountability, Integrity)
26. Take responsibility for their own physical and mental health and refrain from practising physiotherapy while their ability to provide appropriate and competent care is compromised. (Accountability, Integrity)

C. Responsibilities to Self and the Profession

Members of the physiotherapy profession have an ethical responsibility to:

27. Commit to maintaining and enhancing the reputation and standing of the physiotherapy profession, and to inspiring public trust and confidence by treating everyone with dignity and respect in all interactions. (Excellence, Social Responsibility)
28. Commit to lifelong learning and excellence in practice. (Accountability, Excellence)
29. Act honestly, transparently, and with integrity in all professional and business practices to uphold the reputation of the profession. (Accountability, Integrity)
30. Recognize the responsibility to share evidence-informed and clinical best practices in physiotherapy with one another and other health-care professionals. (Excellence)
31. Contribute to the development of the profession through the support of research, mentoring, and student supervision. (Excellence)
32. Refrain from harassment, abuse, or discrimination of colleagues, employees, or students. (Integrity, Respect)
33. Attend to their own health and well-being. (Accountability)

Footnotes

1. A patient is a recipient of physiotherapy services, and may be an individual, family, group, organization, community, or population. In some circumstances a patient may be represented by their substitute decision maker. ↩︎
2. Available here. ↩︎
3. While one of the Core Professional Values is “client-centredness”, Ontario uses “patient” rather than “client”. As such, “patient” is used throughout the document. ↩︎
4. 4. Ontario Human Rights Code (2023): The Code prohibits actions that discriminate against people based on a protected ground in a protected social area. Available here. ↩︎
5. Canadian Human Rights Act (2021): For all purposes of this Act, the prohibited grounds of discrimination are race, national or ethnic origin, colour, religion, age, sex, sexual orientation, gender identity or expression, marital status, family status, genetic characteristics, disability and conviction for an offence for which a pardon has been granted or in respect of which a record suspension has been ordered. Available here. ↩︎

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