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Ethical Decision-Making: Case Studies

Ethical problems often arise in healthcare practice, since the health and lives of patients depend on the decisions of medical staff. For this reason, national associations create guidelines and ethical codes to guide and help doctors and nurses make the right decision. In this paper, I will examine three ethical scenarios and find solutions for them by using the Code of Ethics and the RIPS Model of Ethical Decision Making.

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I use four steps to review and solve all three scenarios and define Realm, Individual Process, and Situation for each of them according to the ethical decision-making model. These steps include recognizing an ethical issue, reflection, making the right decision, and applying it.1 According to the RIPS Model, the first scenario can be characterized as an individual and institutional problem (R), it requires the use of moral courage (IP) in a situation of silence (S).1 I need x-rays to treat people and avoid harming their health, but my colleague neglects his or her duties. Consequently, this situation applies to my performance and the reputation of the clinic. This scenario refers to a situation of silence, since no one talks about a problem and values that it harms. However, according to the Code of Ethics, I am obliged to inform the management about the actions of my colleague as they jeopardize the health of patients.2, 3 In addition, the scenario states that I already asked the doctor for X-rays, but he or she did not respond to the request. Therefore, the only right solution is to report the problem to management, even if it adversely affects my colleague.

The second scenario describes a situation in which I have an individual problem (R) requiring moral motivation (IP) to solve the dilemma (S). The young student does not yet have enough experience and license to treat patients independently, but she shows good results. I have an urgent appointment, so I cannot help all my patients. On the one hand, I can jeopardize the health of patients as a student can make a mistake due to a lack of experience. On the other hand, I will damage my reputation if I cancel the appointment and might also harm patients by delaying treatment. In this case, the solution should be the cancellation of the visit of two patients because this way is more beneficial for their health. In addition, if a student makes a serious mistake, I will bear not only moral but also legal consequences, since, at that moment, I was responsible for her decisions.1 However, before I cancel the appointment, I also need to make sure that the patients do not have urgent problems, delaying, which will seriously harm them.

Another scenario gives a situation in which I made a mistake with the wrong exercises for the patient, and it is known only to me and will affect my reputation. Therefore, this problem is individual (R) and requires moral courage (IP) to overcome temptation (S). 1 In this situation, I am faced with the temptation because I can conceal my mistake and change the course of exercises. However, in this case, the correct decision is to assess the patient’s condition to understand whether my mistake hurt him or her and tell the patient the truth. In addition, if the error had negative consequences, I must work with the therapist who sent the patient to me to develop new recommendations and not take responsibility for my mistake on him or her. This decision is a manifestation of integrity and my professional duties. 2, 3 If the patient asks for another specialist, and I will be punished, such a choice is ethical anyway.

In the process of resolving all of these scenarios, it is also essential to complete all four steps to make an ethical decision. For example, in the third scenario, I could not recognize a moral problem and just change the exercises for the patient without thinking about the consequences. In the situation with the student, an error could arise at the stage of reflection if I do not have enough information, such as urgency and the need for appointments. In all three scenarios, I could have made the wrong ethical decision due to personal considerations or mistakes in the previous steps. For this reason, the fourth step is especially important, in which it is necessary to evaluate the problem once again and check all factors.1 However, all these steps only guide therapists, as well as the Code of Ethics, as each situation is unique.

Therefore, the RIPS Model, the Code of Ethics, and its explanations are relevant and useful sources for making ethical decisions in healthcare. The therapist can quickly identify the main aspects of making a decision and find clues for the next steps. In addition, since the Code of Ethics is mandatory for all medical professionals, violation of its points threatens their career. Consequently, the Code help to make a decision that is more useful for patients, employees, and organizations in general.


Swisher, LL, Arslanian LE. The realm-individual process-situation (RIPS) model of ethical decision making. HPA Resource. 2005; 5(3):1-12. Web.

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American Physical Therapy Association. Code of Ethics for the Physical Therapist. American Physical Therapy Association. Web.

American Physical Therapy Association. APTA Guide for Professional Conduct. American Physical Therapy Association. 2020. Web.

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