Manual Therapies Week 13
Ethical Issues Case Study
John Do is a 15-year-old male who is an avid soccer player. He practices five times a week and plays one to two games competitively on the weekend. He has been experiencing anterior knee/shin pain that is particularly sore after soccer. He has also noticed a lump where the pain is located. His mother, Jane, regularly sees the chiropractor and signed the consent form the night before. She drove John to his appointment; handed him the signed form and said she would be back to pick him up in an hour. John handed the form over and began the session with the chiropractor. The chiropractor told John he had something called “Osgood-Schlatter Disease” and that he was going to help his knee pain by manipulating the spinal lesions in his back. John had never seen a chiropractor, but his mother had told him that the chiropractor regularly “cracks” her back, so he wasn’t too surprised when his back cracked. At the end of the session, the chiropractor told John that he needed three sessions a week for two weeks, then two sessions a week for two weeks and then then one session a week for six weeks. He was advised that if he paid up front, he would receive a 20% discount. As John walked out the room, the chiropractor called, “Oh and no soccer” before disappearing back into the treatment room. John waited in the waiting room for five minutes before his mother came to pay and collect him. The receptionist advised her of the total price for ten weeks of treatments minus the discount. She was surprised at the large sum but paid it reluctantly. She asked John how he went and he replied. “Terrible. I have a disease; he didn’t touch my knee and I can’t play soccer”. She asked what kind of disease, but John couldn’t remember. She became immediately concerned and booked an appointment with her local GP.
Written Reflection
I see the Chiropractor in this case as behaving unprofessionally and unethically. I’m a mum to three children and in the past I’ve signed consent forms for physiotherapy for my son’s football injuries; and permission for teachers at school or on excursions, to apply first aid or to give medicine. If I were John’s mum, I’d be upset that the Chiropractor had acted unprofessionally by telling John he has Osgood Schlatters Disease without explaining the prognosis and treatment options to John, and causing him to become fearful and worried. This disease is commonly seen in growing children, or in overuse injury from sports, and it is repairable or at least manageable.
In connection to this case study – The Health Practitioner Regulation National Law (Tasmania) 2010 is the overarching law for organisations such as AHPRA (Code of Practice for Chiropractors), The Health Complaints Commissioner / Tribunal Tasmania, and the Chiropractors Board of Australia. As John is 15 years old, it would be sufficient for the Chiropractor to explain the condition and prognosis to him, and give him information to bring home with him after the appointment that is intended to inform, and aid in consultation with his family before committing to further treatments (AHPRA).
The law states that if children are under the age of 14 they should have a guardian present to discuss these types of matters with the patient (Health Complaints Act 1995, 2017). John is a member of a sports team, and needs to have information to refer back to his parents and coach about how to manage his condition. In this case he can’t make an informed decision without any information on whether to pursue further treatment, or how long he should modify or stop his sporting commitments. In visiting a General Practitioner, best practice would be to describe the disease process and possible outcomes to John, and inform him of his rights to informed consent and decision making before agreeing to further treatment (AHPRA).
In this situation, I would definitely be able to see that the Chiropractor has behaved unprofessionally and unethically in prescribing future treatments without consultation. Again neither John or his mum have information about the disease or treatment. Under AHPRA registration, the Chiropractor has a legal obligation to practice in line with specifications in the Chiropractors Code of Conduct (AHPRA) Including but not limited to sections in Table 1:
Table 1. Chiropractors Code of Conduct – Relevant Sections
| Chiropractors Code of Conduct AHPRA |
| ‘(2) Providing Good Care’ ‘Recognising the right of clients to make their own decisions’ ‘Shared decision making, and decisions about access to care’ ‘(3) Working with patients’ ‘Children and young people’ ‘Informed consent’ ‘Informed financial consent’ ‘Effective communication and partnership’ ‘Informing patients of the nature and relevance of all aspects of their clinical care, including examination and investigations, giving them adequate opportunity to question or refuse interventions and treatment/care’ (9) Professional boundaries Financial and commercial dealings’ ‘Ensuring the agreement includes a reasonable refund policy, which includes no financial disadvantage for early termination of the agreement’ (AHPRA) |
John and his Mum have a right to make a complaint and receive an apology from the Practitioner, along with reconciliation of behaviour, practice, treatment, and a refund if requested. As John’s Mum, If I’d payed upfront, and later had second thoughts, I’d ask for a written letter from the chiropractor with full disclosure about the treatment and prognosis, along with an option to be refunded if I choose not to go ahead. If the practice stated that paying upfront is agreement to treatment, I would write to the Health Complaints Commissioner Tasmania, to follow up with the practice and Chiropractor to come to an agreement (The Health Practitioners Tribunal). On their website, AHPRA have a flow chart for complaints and have directed those of this nature in Tasmania, however they state that they’re willing to listen to feedback about the practitioners performance and departure from the Code of Conduct, and follow up if other avenues can’t resolve the situation (AHPRA, Concerned about a health practitioner?). I would likely make a verbal or written complaint to AHPRA as well depending on whether both agencies communicate about professional registration status.
In conclusion, a professional Code of Conduct is a guide for the treating practitioner and the client. For the practitioner It aids in things like professional decision making, and professional development, and is a legally binding document. Practitioners can be deregistered or reprimanded if they intentionally or unintentionally don’t follow the Code. All practitioners should act within their scope of practice and refer to other professionals if they’re not confident that they can treat the clients condition. Additionally, professionals can make complaints against other practitioners. A Clients Health Care rights, are supposedly protected in this way to ensure they can trust registered practitioners in seeking treatments. This isn’t always the case though, and therefore it is a good idea to research practitioner qualifications and history before consulting for all treatments involving a level of risk.
Bibliography
Agency, A. H. (n.d.). AHPRA . Code of Conduct for Chiropractors. Melbourne, Victoria, Australia. Retrieved from https://www.chiropracticboard.gov.au/codes-guidelines/code-of-conduct.aspx
AHPRA. (n.d.). Chiropractors Code of Conduct. Parramatta, NSW, Australia. Retrieved from https://www.chiropracticboard.gov.au/codes-guidelines/code-of-conduct.aspx
AHPRA. (n.d.). Concerned about a health practitioner? Parramatta, NSW, Australia. Retrieved from https://www.ahpra.gov.au/Notifications/Concerned-about-a-health-practitioner.aspx
AHPRA. (n.d.). Other health complaints organisations. Parramatta, NSW, Australia. Retrieved from https://www.ahpra.gov.au/Notifications/Further-information/Health-complaints-organisations.aspx
Association, A. C. (2017, February 1). Code of Ethics. Parramatta, NSW, Australia. Retrieved from https://www.chiro.org.au/wp-content/uploads/2019/12/ACA-code-of-ethics2017.pdf
Commission, Health Care Complaints. (n.d.). Consent for Treatment. Retrieved from https://www.hccc.nsw.gov.au/health-consumers/frequently-asked-questions-health-consumers/consent-for-treatment
Justice, T. G. (n.d.). Health Practitioner Regulation National Law (Tasmania) Act 2010,. Hobart, Tasmania, Australia. Retrieved from https://www.justice.tas.gov.au/tribunals/health_practitioners_tribunal
Legislation, T. G. (2017, March 31). Health Complaints Act 1995. Hobart, Tasmania, Australia. Retrieved from https://www.legislation.tas.gov.au/view/html/inforce/current/act-1995-095#GS23@EN
Legislation, T. G. (n.d.). Chiropractors Registration Act 1982. Retrieved from https://www.legislation.tas.gov.au/view/html/inforce/1997-03-01/act-1982-042#GS30@EN
Ombudsmen, N. H. (n.d.). Make a Complaint. -, NSW, Australia. Retrieved from https://www.nhpo.gov.au/make-a-complaint
Practitioners, T. G. (n.d.). The Health Practitioners Tribunal. Health Practitioners Tribunal Act 2010. Hobart, Tasmania, Australia. Retrieved from https://www.healthpractitionerstribunal.tas.gov.au/
Tasmania, H. C. (n.d.). National Code of Conduct for Health Care Workers. National Code of Conduct in Tasmania. Retrieved from https://www.healthcomplaints.tas.gov.au/national-code-of-conduct