The APTA House of Delegates, the association’s highest policy-making body, has authority to adopt ethical principles and standards to govern the conduct of members; its official document is the Code of Ethics --- "a relatively sacred document," explains Wheatley, "something like the Constitution, revised or amended rarely and held in great esteem. The Guide to Professional Conduct is a document ‘beneath’ it that interprets the principles set forth in the code and applies them to practical situations affecting physical therapists, addressing such issues as billing practices, confidentiality, and professional relations." The Code of Ethics also deals with, among other things, disciplinary action, licensure, documentation, liability insurance, malpractice, medical devices/medications, patient relations, and sexual misconduct.

Two years ago the APTA Board of Directors asked the EJC to consider a comprehensive review and revision of the code. The committee completed its review and submitted proposed code changes to the board at APTA’s January 2000 meeting. The changes were submitted to the House of Delegates, which passed the new language last June. The committee went on to revise the Guide to Professional Conduct.

"The last time we’d made any changes to the code," says Nalette, "more than five years ago, there were two primary issues: financial incentives and philosophy. The financial incentives used to be to overtreat a patient. We added language to the guide five years ago to clarify that to overtreat knowingly for financial gain was unethical. Now, with the HMO financial structure, the financial incentives come from undertreatment. We added language to the guide this time to clarify that this is also unethical."

Besides rewriting the ethics code, the EJC reviews charges brought against APTA members after they’ve been first heard by a Chapter Ethics Committee. And it issues opinions on ethics matters brought to it by members. A recent opinion was on physical therapists’ duty to a brain-injured patient when the PTs feel the patient has reached a "therapy plateau" and isn’t making progress. How, the writers asked, can they determine that their duty to the patient is being met; that their time wouldn’t better be spent helping other patients; that the financial, psychological, and physical needs of the patient and her family are

best tended? The EJC opinion addressed the questions, concluding (as well as possible with the information at hand) that the PT was not harming the patient and may in fact have been helping her; that the financial, psychological, and physical needs of the patient and family were being adequately met; and that "a physical therapist would not be acting unethically in deciding to terminate treatment of one patient in order to be able to provide treatment to another patient(s) more likely to benefit from physical therapy services [and that] it might be entirely permissible for [the physical therapist] to transfer to physical therapist assistants or other support personnel some elements of the care of the patient in question."

Nalette, Wheatley, and Hughes are pleased with the process they’ve just finished. "Philosophically, I believe the code had become too legalistic," says Nalette. "Its focus was one of enforcement, rather than focusing on sup-porting members to seek an ideal level of practice. I think the new language moves us in this direction." Wheatley agrees: "The new versions of the code and the guide are designed to move us away from the legalistic mind-set and a ‘crime and punishment mentality,’ to instead be aspirational --- a goal for which we all strive."