The Major Roles of the Pelvic Rehabilitation Therapist as defined in the Code of Ethics

Each profession has its own code of ethics to give guidelines for the professional to act. This is the case for lawyers, doctors, mental health therapists, massage therapists, and accountants to name a few. In pelvic rehabilitation, the APTA and AOTA make different guidelines for physical therapists and occupational therapists respectively.

For physical therapists, the Code of Ethics is built upon the physical therapist's five roles, the profession's core values, and the multiple realms of ethical action. For occupational therapists, the code serves the two purposes of providing aspiration core values in professional and volunteer roles as well as delineating ethical principles and enforceable standards of conduct.

There are many areas of overlap and differences between the roles of physical and occupational therapists in pelvic rehabilitation. This blog will explore the areas that overlap in the world of ethical decision-making. Pelvic floor therapists must complete tasks such as management of patients/clients, consultation, education, research, and administration. Ethical realms can be individual, organizational, and societal and there are various situations an individual can find themselves in when providing care including problems, issues, dilemmas, temptation, distress, and silence.

Some of the main tenets of medical care include beneficence, nonmaleficence, autonomy, and justice. Beneficence is acting in the patient's best interest. Nonmaleficence means "Do no harm" with the care and interactions provided. Autonomy is giving patients the freedom to choose, when and where they are able. Justice is ensuring fairness in patient care.

The AOTA code of ethics tells us that occupational therapists are “committed to promoting inclusion, participation, safety, and well-being for all recipients of service in various stages of life, health, and illness and to empowering all beneficiaries of service to meet their occupational needs.” Likewise the APTA states there is an “obligation of physical therapists to empower, educate, and enable those with impairments, activity limitations, participation restrictions, and disabilities to facilitate greater independence, health, wellness, and enhanced quality of life.”

What can a therapist do to make sure they are practicing ethically? First, they can do a core values assessment. These will vary based on the person’s profession. For example, some core values of a physical therapist include accountability, altruism, collaboration, compassion and caring, duty, excellence, integrity, and social responsibility. Parallelly, occupational therapists have altruism, equality, freedom, justice, dignity, truth, and prudence. You can see there is overlap and similarities between these professions and the expectation of the care they should provide.

One of the pre-course activities I ask participants to perform before doing one of my ethics classes is a core values assessment. This is a great way to check in with where you think you are in your practice and where you may want or need to make changes. After having taught about ethics since 2022, I have found many people are struggling because they want very much to follow rules and be ethical and they simply don’t know where to find the right answers. They turn to Facebook support groups or advice from colleagues and while this information is valuable, it may not always give them accurate information.

The Code of Ethics for PTs and OTs gives clear outlines of the standards of care that these professionals should be providing, but sometimes people need help with the interpretation. It seems so straightforward as you read the document and agree with the words on the paper, but then your patient, employer, or profession throws a curveball at you.

Here are some examples of everyday scenarios pelvic health providers run into that require ethical guideline knowledge and decision-making.

• You have a cancellation policy and the patient canceled in a way that incurred a charge. They give you permission to bill their insurance for the visit so you get paid and they don’t have to pay the fee.
• A patient comes in with their partner and the partner dictates the entire evaluation, refusing to let the patient speak to you alone, and pressuring you to perform tests and measures the patient doesn’t feel comfortable with.
• Your patient needs vaginal dilators and doesn’t feel comfortable asking their provider for a prescription. You struggle with how to advise them.
• You’re a therapist working in the school district and find out a teacher has punished a student on your caseload by putting them in a closet.
• You’re hiring a new provider and they didn’t pass their boards the first time. They ask if they can start treating under your supervision while they study for the next round of boards.
• Pessaries require a prescription in your state but you know your patient would benefit from one and you have a free, unused sample in your office you want to try with them.
• Your patient reports they cannot afford lubricant and you know it would benefit them. You have given them multiple samples. They ask if they can have your large clinical tube.

It is our job as pelvic health providers to know these guidelines, know what our core values are, know the expectations of us as practitioners, and utilize all of this information in a way that benefits all aspects of our patients within our practice. We must continue to aim to do no harm, be truthful, be kind, considerate, inclusive, and aware of all that our clients are going through in order to help them reach their goals. If you feel like these situations happen to you a lot, then you’re likely sensitive to the rules and regulations, and so when a problem arises, your mind flags it and tries to solve it.

If you’re looking for help and guidance in the area of ethics, particularly a crash course in the background of ethics, followed by in-depth application to specific topics, Herman & Wallace has three options of classes to fulfill your continuing education requirements and help ease any burden you may be feeling by the weight of some of these heavier scenarios.

• Ethical Concerns for Pelvic Health Professionals - January 12, 2025
  • The purpose of this class is to explore the ethical challenges Pelvic Health Practitioners may experience including consent, managing trauma and abuse, and preventing misconduct. This course is for any Pelvic Health Professional looking to build skills for ethical evaluation, problem-solving, and derivation of solutions.
• Ethical Considerations from a Legal Lens - November 17, 2024
  • The purpose of this class is to explore the ethical challenges Pelvic Health Practitioners may experience from a health law perspective. This course is for any Pelvic Health Professional looking to build skills for ethical evaluation, problem-solving, and derivation of solutions with a specific focus on the legalities and related concepts. 
• Ethical Considerations for Pediatric Pelvic Health - October 13, 2024
  • The purpose of this class is to explore the ethical challenges pediatric pelvic health practitioners may experience including consent, managing situations of trauma and abuse, and managing autonomy for minors. This course is for any pelvic health professional looking to build skills for ethical evaluation, problem-solving, and derivation of solutions when working with pediatric clients.

AUTHOR BIO:
Mora Pluchino, PT, DPT, PRPC

Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating women, men, and children with a variety of Pelvic Health dysfunction. There is not much she has not treated since beginning this journey and she is always happy to further her education to better help her patients meet their goals.

She strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at the present time. In 2020, She opened her own practice called Practically Perfect Physical Therapy Consulting to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.