Complex Ethics and Jurisprudence Scenario for Rehab Professionals

Disclaimer:  The following is an ethical and jurisprudence scenario, based upon a composite of several cases to protect the identities of those involved.  It is being developed for the update of an Ethics and Jurisprudence course.

Please comment concerning the questions at the end of this scenario. 

Please be respectful of others’ opinions. 

“Abdul” is a PT who was born in the Middle East but immigrated to the USA at a young age and is a US citizen.  He and his family are devout Muslims.

Shortly after graduating with his DPT and passing his boards, Abdul moved to a medium-sized city and started working for a large outpatient therapy company (a national chain in multiple states) in an area catering to the needs of a diverse population.  He quickly established a reputation as an excellent clinician that his colleagues admired, and his patients loved.

One morning as he was reviewing the EMR system to check his caseload for the day, he notes he is scheduled for an evaluation of “Kennedy,” a young patient who has identified as “non-binary” and filled in the section under preferred pronouns as “they/them.”  Abdul frowns, and heads to the office of his site manager.

He meets with Allison, his supervisor, and states gently but firmly he cannot honor the use of the preferred pronouns.  He states that he will honor this patient’s preferred name. His belief and interpretation of the Quran and Hadith is that Allah created just two genders.

As Abdul speaks, Allison stifles an eye roll.  She has profound respect for him as a clinician, but she has had to deal with Abdul and his faith-based arguments before, during the pandemic.  During the slow re-opening of the clinic to live visits, the practice’s parent company had complied with regulations mandating vaccinations of all employees, but Abdul refused. 

The matter was brought to Human Resources, and Abdul utilized Title VII of the 1964 Civil Rights Act to get an exclusion from the mandated vaccination, which prohibits employers from discriminating against individuals because of their sincerely held religious beliefs in hiring, firing, or any other terms and conditions of employment. In addition, the Act requires employers to reasonably accommodate the religious beliefs and practices of employees, unless doing so would cause more than a “minimal burden” on the operation of the employer's business.  Human Resources had validated Abdul had the right to remain employed and not be forced to violate his conscience, and the company had reasonably accommodated him by providing N95 masks for him to wear and regular COVID testing.  Once the COVID restrictions were lifted, Abdul was able to remove the masks and stop testing.

The company had also worked with him to allow daily prayer time and time-off for special religious observances, as well as granting him the time off to fulfill his religious obligation of the Hajj. 

In return, Abdul had demonstrated solid and consistent excellence in his work and attitude towards others and was recognized regularly for his 110% effort.

Now, as Allison (a PT herself) listens to Abdul make his case that he cannot honor pronoun usage, her mind races through several different considerations simultaneously:

1.      According to the APTA code of ethics, a therapist is to consider the needs of the patient ahead of the therapist’s needs (altruism), not treat patients without respect to their preferences (autonomy, respect for persons), and not deny care to a patient due to any prejudices and biases (justice).

2.      According to Title VII of the Civil Rights Act, Abdul is right – he cannot be forced to work contrary to his sincerely held beliefs, and if there are reasonable accommodations to prevent this from happening the clinic must accommodate.

3.      Abdul demonstrates consistently that he works well with all people, regardless of their differences, but Allison is concerned that his stated bias in this case may create a situation where the patient’s rights are violated.

4.      Moving the patient to another’s schedule, like hers, may be possible, but she already has a patient scheduled at the same time.

5.      Cancelling the patient’s visit at the last minute would not be fair to the patient, since Kennedy may have taken the day off from work, etc.

6.      She could council Abdul that his beliefs are wrong, but she knows better than to challenge sincerely held religious beliefs at work due to her training on Title VII.

7.      She believes she cannot make a case against accommodation of his beliefs, so will need to figure out some form of accommodation, then perhaps discuss the matter with Abdul and HR.

Finally gathering her thoughts, Allison addresses Abdul concerning how they can both accommodate Abdul’s sincerely held religious beliefs and respect Kennedy.

Questions:

1)      Are there other concerns/considerations that Allison should have prior to finalizing her approach to this dilemma?

2)      What are the responsibilities that Abdul has to Kennedy?

3)      What are the responsibilities of the employer to Abdul?

4)      What solutions do you think would best honor both the ethical standards governing the care of the patient and the legal protections for the therapist?