Code of Ethics

Physiotherapists are responsible for conducting themselves ethically in every professional practice situation. To assist physiotherapists to determine the most appropriate ethical conduct in situations of uncertainty, the College of Physiotherapists of Ontario has adopted a values-based Code of Ethics and a stepwise decision-making model.

Updated: Recently Updated
March 2013

The Code of Ethics reflects physiotherapists’ commitment to use their knowledge and expertise to promote high quality, competent and ethical care for patients and thereby instill in the public, confidence in the profession.

The ethical values for physiotherapists in Ontario spell out the acronym R.E.A.C.H. These values should be applied in all aspects of professional practice, particularly in the patient-physiotherapist relationship and when facing an ethical problem or dilemma.

Making ethical decisions is not always easy and can be accompanied by significant discomfort. While the Code of Ethics cannot alleviate this discomfort, adopting the R.E.A.C.H. values and a standard process to analyze a situation will allow physiotherapists to feel more secure in their ability to make the best decision possible and that is also in the best interest of their patients.

There are a variety of ethical decision making models available, and although one version is presented here, physiotherapists should choose a model that is most comfortable for them and meets their professional needs.

Physiotherapists should also understand that while a consistent process can be followed each time an ethical decision is required, the decision or outcome can vary and there can be differences of opinion. It is not expected that there will always be complete agreement as context is critical. The proposed actions to an ethical dilemma can include both those who are in favour and those who are opposed to the decision. Although there may not be complete agreement on one unique line of action, some actions will be more defensible and others will be less defensible. 

An online learning module is available on the College website to facilitate understanding of:

  • ethics in general
  • the ethical values of physiotherapists in Ontario
  • how to apply the values and a standardized decision-making process to ensure the best decision possible

The ability to make appropriate ethical decisions that are in the best interests of patients is an essential aspect of professional practice.

Ethical Values

Respect

Physiotherapists are respectful of the differing needs of each individual and honour the patient’s right to privacy, confidentiality, dignity and treatment without discrimination.

Excellence

Physiotherapists are committed to excellence in professional practice through continued development of knowledge, skills, judgment and attitudes.

Autonomy and Well Being

Physiotherapists are at all times guided by a concern for the patient’s well-being. Patients have the right to self-determination and are empowered to participate in decisions about their health-related quality of life and physical functioning.

Communication, Collaboration and Advocacy

Physiotherapists value the contribution of all individuals involved in the care of a patient. Communication, collaboration and advocacy are essential to achieve the best possible outcomes.

Honesty and Integrity

Each physiotherapist’s commitment to act with honesty and integrity is fundamental to the delivery of high quality, safe and professional services.

Steps to Ethical Decision Making

  1. Recognize that there is an ethical issue—i.e. something is making you uncomfortable.

  2. Identify the problem and who is involved—What is making you uncomfortable? Who else is involved?

  3. Consider the relevant facts, laws, principles and values—What laws or standards might apply? What REACH value or ethical principle is involved?

  4. Establish and analyze potential options—Weigh possibilities and outcomes. Use your moral imagination.

  5. Choose a course of action and implement it—Are there any barriers to action? What information should be recorded?

  6. Evaluate the outcome and determine if further action is needed—What did you learn? What can you do to prevent future occurrence?

Revised March 2013



Related Laws and Legislation

Ethical Dilemmas FAQs

I believe my patient is suicidal. Can I break confidentiality?

Practice Scenario:

Duty to Warn

When Tonia Toffler was applying the ultrasound probe, her patient mentioned thinking of suicide. At first she wondered if the patient was making light of his difficulties or being overly dramatic...

Read more

Duty to Warn

‘Duty to warn’ is a provision in the law allowing you to break confidentiality when, using best judgment, you decide it’s of utmost importance to keep a patient safe. Normally, privacy laws prevent disclosure of patient health information. But if someone’s in danger, duty to warn takes precedence. If harm isn’t urgent, you must obtain patient consent to proceed with release of any patient health information; without permission, your hands are unfortunately tied. But you should continue to monitor the situation have helpful information available, and if it worsens, consider acting.

Consider these Key Points in each scenario

  1. A PT needs to keep patient health information confidential.

  2. If there is a considered risk of patient harm, then a PT might break the confidentiality to prevent harm

  3. A considered risk is when a PT believes the patient might have the intent and the means to cause harm to self or to others.

Example 1

Tonia Toffler knew her patient was dispirited with his progress in the range of motion exercises they’d been working on. But it completely caught her off-guard when, as the two were alone together in the treatment room and Tonia Toffler was applying the ultrasound probe, her patient mentioned thinking of suicide. At first she wondered if the patient was making light of his difficulties or being overly dramatic, but when his comments took on the character of personal confessions, she knew she was in over her head. She was trained as a physiotherapist, not a psychotherapist. This situation was beyond her professional responsibility to diagnose or treat. But she did have a responsibility to do whatever she could to ensure her patient’s safety. Judging that suicidal ideation, in this case, wasn’t at a critical point, she obtained her patient’s consent to contact his family doctor and suggest referral to a counselor. If things had been worse, she might’ve found a way to reach her Doctor directly. 

Example 2

His patient didn’t usually wear exercise clothing to appointments where they’d be spending time in the clinic gym, which didn’t make sense to John because in clingy long-sleeve shirts and heavy pants, the patient found it difficult to stretch. It was almost by accident that the forearm cuts became visible one day when the patient used her sleeve to wipe sweat from her brow. At first John pretended not to have noticed, giving himself time to think of what to do. He waited until he and his patient were behind a closed door in the main office before asking if she’d had a chance to talk with anyone about the cutting. He asked if he could get help for her. She said no and was evasive in her responses, John was worried about her emotional state of mind and her ability to understand the risks. John decided to privately contact her parents and doctor after the session.

Example 3

All through the appointment, Tammy’s patient had been off-balance, confused and somewhat belligerent. Though there wasn’t any obvious smell of alcohol, she was convinced the man was drunk or under the influence of something else. At the end of the day’s treatment, when she asked him how he was getting home, this patient became verbally abusive and told Tammy it was none of her business. She knew the man had driven himself to the clinic that day; she could still see his car parked on the street outside. It seemed inevitable that he’d be a danger to himself or others if she let him leave. So she excused herself to the bathroom and called police.

Contact the Practice Advisor

Every situation is different. If you have any doubts about what to do, contact the Practice Advisor at practiceadvice@collegept.org or 647-484-8800 or 1-800-583-5885.

Practice Advisor

If you are dealing with an ethical dilemma and you have any doubts about what to do, contact the Practice Advisor at practiceadvice@collegept.org or 647-484-8800 or 1-800-583-5885.