Professional Roles, Ethics, and Legal/Regulatory Issues
What the exam expects
You must apply ethical principles (autonomy, beneficence, nonmaleficence, justice, fidelity) to pediatric practice, where the child is the patient but parents/guardians hold legal decision-making authority. Know informed consent and assent, confidentiality and mandated reporting, scope of practice, supervision and delegation, and documentation standards.
Key concepts
Understand the therapist's duty to report suspected abuse or neglect, the limits of parental consent when a child's interests are at stake, and how to handle conflicts between family wishes and clinical recommendations. Know billing and documentation integrity, fraud and abuse basics, and the role of licensure and practice acts. Recognize the difference between an ethical dilemma and a legal requirement.
Traps
Questions often present a scenario where a parent refuses a recommendation-the correct answer usually involves education, collaboration, and documentation, not unilateral override. Another trap: confusing assent (child's agreement) with consent (guardian's legal authorization). Watch for delegation questions where the task exceeds the assistive personnel's scope.
Rule of thumb: When family and clinician disagree, educate, collaborate, document, and escalate only when safety requires it.
Worked example: A parent declines a recommended orthosis. The therapist should explain rationale, explore barriers, document the discussion and the family's decision, and continue to monitor-not simply discharge or override the parent.