Ethical issues raised by private practice physiotherapy are more diverse than first meets the eye: recommendations from a literature review.
OBJECTIVE
Physiotherapy in private practice differs from physiotherapy practised in a public setting in several ways, the most evident of which is the for-profit nature of private physiotherapy clinics; these differences can generate distinct and challenging ethical issues. The objectives of this article are to identify ethical issues encountered by physiotherapists in private practice settings and to identify potential solutions and recommendations to address these issues.


METHODS
After a literature search of eight databases, 39 studies addressing ethical issues in a private practice context were analyzed.


RESULTS
A total of 25 ethical issues emerging from the included studies were classified into three main categories: (1) business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time affecting quality of care); (2) professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) patients' rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs. patient autonomy, informed consent). Recommendations as to how physiotherapists could better manage these issues were then identified and categorized.


CONCLUSIONS
The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported-through education, research, and good governance-in providing the best possible care for their patients.
Rehabilitation Sciences Program, École de réadaptation, Faculté de médecine, Université de Montréal ; Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal.
Anne
A
Hudon
Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, Que.
Marie-Josée
MJ
Drolet
Bioethics Program, Department of Social and Preventive Medicine, École de santé publique Université de Montréal ; Institut de recherche en santé publique de l'Université de Montréal.
Bryn
B
Williams-Jones
ethics; private practice; private sector; professional