title: Constrained physical therapist practice: an ethical case analysis of recommending discharge placement from the acute care setting.
abstract: OBJECTIVE
  Constrained practice is routinely encountered by physical therapists and may limit the physical therapist's primary moral responsibility-which is to help the patient to become well again. Ethical practice under such conditions requires a certain moral character of the practitioner. The purposes of this article are: (1) to provide an ethical analysis of a typical patient case of constrained clinical practice, (2) to discuss the moral implications of constrained clinical practice, and (3) to identify key moral principles and virtues fostering ethical physical therapist practice.
  
  
  METHODS
  The case represents a common scenario of discharge planning in acute care health facilities in the northeastern United States.
  
  
  METHODS
  An applied ethics approach was used for case analysis.
  
  
  RESULTS
  The decision following analysis of the dilemma was to provide the needed care to the patient as required by compassion, professional ethical standards, and organizational mission.
  
  
  CONCLUSIONS
  Constrained clinical practice creates a moral dilemma for physical therapists. Being responsive to the patient's needs moves the physical therapist's practice toward the professional ideal of helping vulnerable patients become well again. Meeting the patient's needs is a professional requirement of the physical therapist as moral agent. Acting otherwise requires an alternative position be ethically justified based on systematic analysis of a particular case. Skepticism of status quo practices is required to modify conventional individual, organizational, and societal practices toward meeting the patient's best interest.
authors.affiliation: Department of Physical Therapy, Ithaca College, Rochester, New York. Mailing address: 1100 S Goodman St, Rochester, NY 14620, USA. enalette@ithaca.edu
authors.forename: Ernest
authors.initials: E
authors.lastname: Nalette
mesh_terms: D003657:Decision Making; D026689:Ethical Analysis; D004995:Ethics, Professional; D006301:Health Services Needs and Demand; D006801:Humans; D009014:Morals; D010351:Patient Discharge; D026761:Physical Therapy Specialty / Q000941:ethics*; D012047:Rehabilitation Centers