1. Recognize that there is an ethical issue

2. Identify problem and who is involved 

• The patient is making racist remarks towards other staff members. 
• Seeing this may invoke an ethical dilemma as it may be difficult to treat a patient who you have seen yell at your colleagues and said racist remarks

3. Consider relevant facts, laws, principles and values

– What laws or standards may apply, what ethical principle is involved

– Respect is an ethical value that has not been observed by the patient

– Although you are committed to excellence, well being, honesty and integrity, if the patient continues with his remarks, you can ethically discharge the patient

4. Establish potential options

• Communicate with the patient about the remarks and ask the patient to stop. 
• If he stops then you can treat, if not you are able to discharge. 
• It is important to dictate to the patient that if his behaviour continues you will discharge him and explain the risks to stopping physiotherapy.

5. Choose your course of action, implement it

6. Document decision

7. Evaluate outcome and determine if further action is needed