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Ethical Issues in Physical Therapy Practice A Survey of Physical Therapists in New England ANDREW A. GUCCIONE, MS This survey was an attempt to identify which ethical decisions are most fre- quently encountered and are most difficult to make for practicing physical therapists. A questionnaire that described 30 situations with an ethical dimen- sion was sent to 450 American Physical Therapy Association members practicing in New England. A total of 187 (41.5%) usable questionnaires was returned. Issues raised by items were designated as primary, secondary, or nonpriority. Seven primary and 11 secondary ethical issues were identified. In brief, these issues involve the decision about which patients should be treated, what obli- gations are entailed by that decision, who should pay for treatment, and what duties derive from the physical therapist's relationship with other health profes- sionals, including physicians. Some of these decisions are more frequent in certain types of employment facilities than in others. Sources of ethical conflict and the role of the professional organization in defining moral values for the profession are discussed in this paper, and implications for education are presented. Key Words: Ethics, medical; Ethics, professional; Physical therapy. The need to identify and clarify ethical issues within a health profession increases as the profession assumes responsibility for those areas of direct patient care in its domain. A brief comparison of the 1935 American Physiotherapy Association CODE OF ETH- ICS with its 1977 American Physical Therapy Asso- ciation (APTA) counterpart reflects the development of physical therapy as a profession in its own right. 1 The physical therapist today, in defining the limits of his legal and professional autonomy, must examine the practice of his profession from an ethical point of view. By doing so, he carefully guards the rights of patients, maintains his integrity as a professional, and promotes the ideals of physical therapy as a profes- sion. Thompson has suggested that there are three sources of conflict for health professionals making ethical decisions. 2 First, conflicts may arise between an individual's private convictions and his conception of the requirements of his professional role. Second, ethical dilemmas may be encountered when the atti- tudes, values, and goals of one profession conflict with those of another. Finally, the ethos (ideology) of a profession and that of the society in which it func- tions may be in conflict. Professional ethics has developed in response to these sources of conflict, and the APTA CODE OF ETHICS and the guidelines for its interpretation emerge historically and sociologically with that de- velopment. 1 The CODE may be regarded as an attempt to counsel physical therapists making ethical judg- ments by asserting the ideals of the profession and by defining some of the limits of professionally and morally acceptable behavior. Continuing documen- tation of the ethical concerns of practicing physical therapists is essential to maintain timely counsel. The twofold purpose of this study was to identify which ethical problems were perceived by physical therapists to be the most frequently encountered and Mr. Guccione was a candidate for the degree of Master of Science in Physical Therapy at Sargent College of Allied Health Professions, Boston University, when this study was conducted. He is currently Staff Physical Therapist, Physical Therapy Department, Massachu- setts Rehabilitation Hospital, 125 Nashua St, Boston, MA 02114 (USA). Adapted from a paper presented at the Fourth Annual Convention of the Massachusetts Chapter, American Physical Therapy Associa- tion, Hyannis, MA, April 1978. This article was submitted April 2, 1979, and accepted January 4, 1980. 1264 PHYSICAL THERAPY
Transcript of ichimoku
Stocks & Commodities V. 18:10 (22-30): Ichimoku Charts by Ken Muranaka
Copyright (c) Technical Analysis Inc.
CLASSIC TECHNIQUES
by Ken Muranaka
The Mountain Man Is Back,This Time In Computerized
Trading Rooms
Invented before World WarII by a Tokyo newspaperwriter who called himself“Ichimoku Sanjin” (a penname meaning “a glance of
a mountain man”), ichimoku chartsare becoming a popular tool forJapanese traders once more, notonly in equities but also in curren-cies, bonds, indices, commodities,and options. Literally, ichimokumeans “one look”; a chart of thisstyle is referred to as ichimokukinkou-hyou — the table of equili-brium prices at a glance.
Ichimoku’s guidebook on thecharts finally appeared in 1968,long after the newspaper writer,whose real name was GoichiHosoda, developed the technique.All the computations involved nomore than taking midpoints ofhistorical highs and lows in vari-ous ways. Nevertheless, the com-pleted chart presents a panoramic
IchimokuCharts
A Japanese charting techniquedeveloped early in the 20th cen-tury is enjoying renewed popu-larity.
KEN
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Gold: June 2000
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Standard lineTurning lineDelayed lineClose1st preceding span2nd preceding span
Cloud
view of price movement. For years, Hosoda hired students todo numerous calculations (or simulations) to come up with theoptimum formulas, long before personal computers or evenpocket calculators were the norm. He died in 1983, but the spiritof his work is in computerized trading rooms in the form ofichimoku charts. Although he also developed some wavetheories, I’ll only cover the chart style here.
CONSTRUCTING AN ICHIMOKU CHARTAn ichimoku chart consists of:
1 The standard line,2 The turning line,3 The delayed line,4 The first preceding span, and5 The second preceding span.
Today’s point in the standard line is computed by the formula
for the past nine days, including today.Now write down these computed values in a table or spread-
sheet, which in Japanese is called kinkou-hyou (the table ofequilibrium prices). Next, in this table record today’s closingprice 26 days prior to today. This becomes a point in thedelayed line. (See sidebar “Computing ichimoku lines” fordetails in a spreadsheet.)
The first preceding span is computed using the standard andturning lines by the formula
for the past 26 days, including today.In a similar way, the turning line is computed by the formula
FIGURE 1: ICHIMOKU CHART. June gold 2000 jockeys within the confines of lines generated by its own movement. Ichimoku charts are meant to portray the tradable’s positionwithin its expected trading range. The most recent prices are in the cloud, indicating a lack of direction.
Turning line =Highest high + Lowest low
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1st preceding span =Standard line + Turning line
2
2nd preceding span =Highest high + Lowest low
2
and the computed value is entered in the same table 26 daysahead of today, counting today.
Finally, the second preceding span is computed from thehistorical prices as
for the past 52 days, including today, and this value is againrecorded in the table 26 days ahead of today, counting today.Using a spreadsheet or analytical program, chart these linesalong with your pricing (Figure 1).
Standard line =Highest high + lowest low
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Stocks & Commodities V. 18:10 (22-30): Ichimoku Charts by Ken Muranaka
Copyright (c) Technical Analysis Inc.
COMPUTING ICHIMOKU LINESYou should be able to displayichimoku charts in your spread-sheets using formulas similar tothese Excel formulas.
First, prepare the data in col-umn format using date, high, low,and close. The open is not used.Then enter the formulas shown insidebar Figure 1 for columns E, F,
G, K, and L. Copy them all down to the end of the data.Column G, the delayed line, will end in a series ofzeroes because it looks ahead in the data to see whatthe values are in the future. This formulation, whileunusual to Western eyes, is correct.
Because columns I and J start so far into the data,they aren’t shown on sidebar Figure 1. Instead, enterin cell I52 the following formula for the first precedingspan:
=(E27+F27)/2
Copy cell I52 down to the end of the data. Then, in cellJ78, enter the following formula for the second pre-ceding span:
=(MAX(B2:B53)+MIN(C2:C53))/2
and copy it down to the end of your data.Using the charting facility for your spreadsheet, create a
multiple data series chart. In Excel, the specifications for thelines (using our gold example with 268 rows of data) are:
Standard line =SERIES(Gold!$E$1,Gold!$A$2:$A$268,Gold!$E$2:$E$268,1)
Turning line=SERIES(Gold!$F$1,Gold!$A$2:$A$268,Gold!$F$2:$F$268,2)
Delayed line=SERIES(Gold!$G$1,Gold!$A$2:$A$268,Gold!$G$2:$G$268,3)
Close=SERIES(Gold!$D$1,Gold!$A$2:$A$268,Gold!$D$2:$D$268,4)
First preceding span=SERIES(Gold!$I$1,Gold!$A$2:$A$268,Gold!$I$2:$I$268,5)
Second preceding span=SERIES(Gold!$J$1,Gold!$A$2:$A$268,Gold!$J$2:$J$268,6)
This model is available for download to STOCKS & COMMODI-TIES subscribers on the S&C Website at http://technical.traders.com/sub/sublogin.asp. —K.M.
SIDEBAR FIGURE 1: COMPUTING ICHIMOKU. Here’s how to compute ichimoku using anExcel spreadsheet.
= (MAX(B2:B27)+MIN(C2:C27))/2
=D27
= (MAX(B2:B10)+MIN(C2:C10))/2
Open is not used
See text
SIMILAR BUT DIFFERENTBy and large, the calculations for ichimoku charts are similarto moving average techniques but use the historical highs andlows rather than a series of closing prices. Hosoda believed thatmidpoints within a time span reflect price characteristics muchbetter than means.
Note the key time spans of nine, 26, and 52 days in hisformulas. The time span of 26 days would correspond to thenumber of business days (Saturdays included) in one monthwhen this charting method was devised and tested. So the timehorizons of nine, 26, and 52 days represent a week and half; amonth; and two months, respectively.
Some other values of these time spans may be more predic-tive when the chart is used in today’s markets. As an illustrativeexample, I’ve followed the original ichimoku formulas topresent Figure 1, a chart of the gold futures listed at the TokyoCommodity Exchange. The historical data was downloaded
from the exchange’s Website. Figure 1 shows the June 2000contract of gold futures prices (July 1, 1999, to June 27, 2000).
AN ICHIMOKU CHART EXPLAINEDFigure 2 is the same series with moving averages that have beencomputed using the same time spans (nine and 26 days) as theichimoku’s standard and turning lines. The lines of the movingaverages are more smoothed than the lines of the standard andturning lines that are created by taking midpoints of thehistorical high and low prices. Other than this difference, thetraditional moving average technique and the ichimoku standard/turning lines would give a similar result. As in the movingaverages, a buy signal is initiated when the turning line shootsabove the standard line, whereas the sell signal is the opposite.
Moving averages reflect the consensus of investor expecta-tions over a specified period in terms of the average of closingprices. Gold prices would not rise much without the market
Stocks & Commodities V. 18:10 (22-30): Ichimoku Charts by Ken Muranaka
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price rising above the average price seen in the past. Thatargument also applies to the ichimoku method of quantifyingthe market expectation over a specified time span.
Prices would not rise much without the market pricegoing above the midpoint of highs and lows. The ichimokuchart is a trend-following indicator and so would lead tosuccessful trading when gold prices move in relatively longtrends. However, it would not perform that well in sidewaysmarkets. (As I mentioned previously, ichimoku charts weredevised before the age of computers or pocket calculators;it is likely that taking midpoints were computationally lessof a burden than taking averages.)
FURTHERIn looking at the delayed line, first note that, because it isdelayed, it ends before the current close. Thus, you go back towhere it ends and check whether it is above or below the closeof that date. For example, the gold market has strengthenedwhen the delayed line is above the closing prices at that pastdate; otherwise, the market would have declined. This issimply a comparison of the current prices with the prices as ofa month ago, and the quick comparison is the only use of thedelayed line.
The ichimoku technique’s ingenuity lies in the precedinglines to define support and resistance levels. The standard andturning lines indicate the consensus of the market participantsover the specified time horizons, so a rising trend will be
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Close9-day moving average26-day moving average
revealed by successively higher lows, while a declining trendwill be given by successively lower highs.
An old Japanese saying states, “Ask the market about themarket.” With that in mind, the current market price of gold
FIGURE 2: AVERAGES. Averages also track the gold prices shown in Figure 1. Compare the two charts by considering the averages as the standard and turning lines thatyou’d find in an ichimoku chart. This shows that an ichimoku chart is a form of trend-following system.
should contain all the information that is known to investors.Therefore, the average value of the standard and turning linesmust be the best predictor of future price. These becomeichimoku’s first preceding span.
A trend defined by computing the midpoints of highs andlows in the past 52 days (that is, two months) should containsuch factors as supply and demand along with expectations inthe past. This trend is then time-shifted one month down theroad to represent the second preceding span.
The region between the two preceding spans is referred to askumo, meaning “cloud,” and defines support or resistance. Abreakout above the kumo indicates the breakout above theresistance level. Again, this concept is similar to moving
An ichimoku chart is a trend-followingsystem with an indicator similar to movingaverages. What makes it unique, however,is found in the strategy to time-shift thetrendlines to the past for the delayed lineand to the future for the preceding lines.
Stocks & Commodities V. 18:10 (22-30): Ichimoku Charts by Ken Muranaka
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averages. It is possible that market expectations on gold pricesquickly change and the prices return to the cloud (support/resistance), defining the support/resistance level after a pricebreakout has been observed. However, the risk of such trapsor false breakouts should be much less for the ichimoku chartthan the comparable moving average chart, as the ichimoku’stwo preceding spans are deliberately shifted (exactly onemonth in Hosoda’s formulas) to the future. When gold pricesare loitering in or near the cloud, it would be better to wait forthe market price to go above or below the cloud. If the pricesare above the cloud, the sun is shining and it would be a timeto buy. If the prices are below the cloud, it’s raining and itwould be a time to sell.
When all of the delayed lines, the standard/turning lines,and the cloud indicate the same signal to buy or sell, the chartshould be showing a trend. But in sideways markets, anichimoku trend-following system can be risky, and oscillatorsshould be monitored.
REMARKSAn ichimoku chart is a trend-following system with an indica-
tor similar to moving averages. What makes it unique, how-ever, is found in the strategy to time-shift the trendlines to thepast for the delayed line and to the future for the precedinglines. By doing so, we can look at market timing, resistance/support, and possibly false breakout, all in one chart, in onepanoramic view (ichimoku).
The time spans of nine, 26, and 52 may be changed for thecurrent markets, as securities are not currently traded onSaturday. Ichimoku charts can easily be constructed usingspreadsheet software such as Excel or Lotus. Optimized valuesfor the time spans can be found without years of calculations byusing spreadsheets.
There are some difficulties applying them today, sincemarkets such as foreign currencies trade 24 hours a day aroundthe globe; we must devise a way to define opening and closingprices. In addition, derivatives are relatively short-lived. How-ever, analysts familiar with these problems will be able to applyichimoku charts to virtually any market.
Ken Muranaka is a private trader.
†See Traders’ Glossary for definition
