A Retrospective Analysis of Ethics Knowledge in Physical Therapy (1970–2000)

Abstract

Background and Purpose. Purtilo, Guccione, and others have noted that increased clinical autonomy for physical therapists presents more complex ethical dilemmas. The body of literature examining physical therapy ethics, however, is relatively small and has not been analyzed. The primary purposes of this research were: (1) to use multiple perspectives to describe and analyze literature examining ethics in physical therapy from 1970 to 2000, (2) to develop a model to describe the evolution of knowledge of ethics in physical therapy during this period, and (3) to compare the proposed model with the evolutionary models proposed by Purtilo in physical therapy and by Pellegrino in bioethics. Sample. The sample consisted of peer-reviewed journal articles cited in the MEDLINE or Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases between 1970 and 2000 or referenced in Ethics in Physical Therapy. Methods. A two-phase mixed quantitative and qualitative method was used to analyze publications. In the quantitative phase, the author sorted publications into a priori categories, including approach to ethics, author, decade, country of publication, role of the physical therapist, and component of morality. During the qualitative phase of the research, the author analyzed and sorted the publications to identify common themes, patterns, similarities, and evolutionary trends. These findings were compared with the evolutionary models of Pellegrino and Purtilo. Results. The 90 publications meeting inclusion criteria were predominantly philosophical, using the “principles” perspective; focused on the patient/client management role of the physical therapist; and addressed the moral judgment component of moral behavior. As predicted by Purtilo's model, the focus of identity evolved from self-identity to patient-focused identity, with increasing representation of societal identity. Recurrent themes included the need to further identify and clarify physical therapists' ethical dilemmas, the interrelationship between clinical and ethical decision making, and the changing relationship with patients. Discussion and Conclusion. Although knowledge of ethics grew steadily between 1970 and 2000, this retrospective analysis identified gaps in our current knowledge. Further research is needed to address the unique ethical problems commonly encountered in all 5 roles of the physical therapist; patient perspectives on ethical issues in physical therapy; variety in ethical approaches; factors affecting moral judgment, sensitivity, motivation, and courage; and cultural dimensions of ethical practice in physical therapy.

Ethical perspective on quality of care: the nature of ethical dilemmas identified by new graduate and experienced speech pathologists

“…The ethical dilemmas identified by our participants are not unique to the speech pathology profession. Allied health, medical and nursing professions are confronted by the challenges of an evolving healthcare system (Barnitt 1998, Purtilo 2000, Shinn 2004, Swisher 2002). Hence, these ethical challenges present healthcare professionals with new opportunities for collaboration, education and research in applying, maintaining and refining codes of ethics relevant for contemporary practice.…”

“…Previous research indicates that health professionals are confronted by a range of ethical dilemmas in the workplace (Barnitt 1998, Swisher 2002). These dilemmas included managing unethical behaviour by colleagues, clients disagreeing with intervention approaches, difficulties assigning treatment priorities, inadequate supervision and training, and external constraints on clinical decision‐making (Buie 1997).…”

Patient’s Perception of Autonomy Support and Shared Decision Making in Physical Therapy

“…Compared to the medical research field, studies on the concept of patient involvement are still scarce in physical therapy literature. The opportunities to use SDM in healthcare have been previously described in ethicsbased studies [18]- [22], and the current level of SDM use in physical therapy was recently investigated in an observational study performed in thirteen autonomous physical therapy settings at the Flemish part of Belgium [23]. However, our observational study [22], as well as various studies in the field of general practice [23]- [26], reported that SDM was rarely implemented in clinical practice.…”

Aspectos éticos e humanizados da fisioterapia na UTI: uma revisão sistemática

“…Em relação ao direito, o Estado precisou intervir nas relações para melhor defini-lo, a necessidade era e é de um agente imparcial para mediar os conflitos das relações humanas, criando-se então os códigos, leis e normas (7,9). No que se refere às categorias profissionais, surgiu a necessidade de estabelecer regras com a finalidade de instituir os princípios ético-morais pelos quais os profissionais poderiam se guiar, regulando, assim, sua atuação.…”