Forging Links to Moral Action: Reaching Beyond Boundaries

Swisher L.L.¹, Jensen G.M.², Delany C.³, Adel A.A.⁴, Praestegaard J.⁵

¹University of South Florida, School of Physical Therapy & Rehabilitation Sciences, Tampa, FL, United States of America, ²Creighton University, Graduate School, Omaha, NE, United States of America, ³The University of Melbourne, Physiotherapy, Melbourne, Australia, ⁴Physical Therapy Institute (PTI), Physiotherapy, Kabul, Afghanistan, ⁵Metropolitan University College, Centre for Interconnected Social and Health Care, Copenhagen, Denmark

Learning objectives:

1. Discuss the scope and the limitations of physical therapy codes of ethics for guiding moral agency 2. Evaluate the implications for physical therapy ethics of a broadened framework that address the individual-family-community-society continuum 3. Generate strategies for physical therapy educators and practitioners to link ethical concepts (care, justice, social policy, solidarity, vulnerability) to the broadened framework for moral action 

Description:

Physical therapists around the world refer to codes of ethics for guidance. Codes of ethics provide important guiding principles and establish ethical expectations of practice for physical therapists and for those who seek their services. However, in the context of the diversity and complexity of ethical issues that physical therapists encounter in clinical practice, they also have limitations. One important limitation of codes of ethics is that most codes have developed out of the same dominant western ethical foundation. This foundation is underpinned by four prima facie moral principles - respect for autonomy, beneficence, non-maleficence, and justice. It is claimed that this homogenous approach to ethics education accommodates cultural differences (Beauchamp and Childress, 2007). However, there is debate about the 'universality' and neutrality of principlism. Some Asian scholars have argued that Asian bioethics is essentially different from American approaches (Fan 1997, Sakamoto 1999, Qiu 2004). A frequent criticism is that principlism reflects Western ideals such as the importance of individual rights and self-determination. Some European scholars also criticize the emphasis that American bioethics places on patient autonomy as the central value (Justo and Villarreal 2003, Veatch 2000).

In particular, the foundational assumptions of this tradition may not be congruent with the values of non-western societies, and they may de-emphasize ethical concepts that may be important to physical therapists working in different cultural contexts. The western ethical foundation emphasizes the importance of universal ethical principles applied to the individual autonomous person, with considerably less attention to communal concepts such as care, interdependence, solidarity, vulnerability, and socio-communal values. Moral judgments which address these latter concepts draw from important related concepts (individual and community, justice, and care, health care plan and family goals, autonomy and accountability, clinical evidence and ethical values) as competing and dichotomous considerations. These judgments may not be well captured by traditional moral frameworks.

A second limitation of codes of ethics is the implicit assumption that physical therapists have the required professional autonomy to implement the ethical obligations derived from the codes. In many situations physical therapists are required to balance competing values and interests and make ethical decisions about appropriate treatments in situations where they do not have full responsibility or authority to decide a course of action.

Further development of physical therapy ethics requires that we reach beyond the traditional boundaries of traditional ethical decision-making frameworks and their underlying culturally based foundational concepts. The panel will broaden the discussion of physical therapy ethics to include an individual-family-community-society continuum as an approach to broaden our understanding of the nature and scope of physical therapy ethics. It will also explore notions of moral agency in physical therapy practice and forge links between ethical concepts and moral action.

This session will explore the strengths and potential limitations of traditional ethical models including professional codes of ethics and highlight new theoretical models to link theory and practice. Implications of these models for physical therapy ethics education and practice will be explored in the context of social determinants of health, communitarian cultures (Afghanistan and Mexico), and integration of the individual-family-community-society continuum into notions of moral agency. Discussion will identify specific strategies for educators and practitioners to address the boundaries of culture and traditional ethical frameworks. In addition, discussion will highlight ongoing approaches to encourage moral dialogue across cultural and national boundaries.

Implications / Conclusions:

Moral agency in an increasingly global community requires physical therapists to transcend the theoretical, conceptual, cultural, and national barriers of the past. Moral dialogue in physical therapy across cultures has the potential to fundamentally transform the practice of physical therapy into an interdependent global learning community.

Discussion:

Ruth Purtilo (United States of America) and Ian Edwards (Australia) will lead a panel discussion at the end.

Keywords:

Ethics; Clinical practice; Professional education

Funding acknowledgements:

None

Relevance to WCPT and expected audience:

The central theme of this symposium (reaching beyond traditional ethical foundations of physical therapy practice to address social and cultural differences and determinants of health care) is very relevant to the WCPT belief in 'culturally appropriate healthcare' and 'trust and respect for human dignity.' This symposium promotes communication and exchange of information across cultures and the physical therapy profession. This symposium would be of interest to physical therapists in a variety of roles and settings.

Target audience:

Since every physical therapist must make ethical decisions, appreciation of limitations of codes of ethics should be of interest to clinicians, educators, managers, and researchers.

View all focused symposia