How physiotherapists perceive, interpret, and respond to the ethical dimensions of practice: A qualitative study

Abstract

The profile and reach of physiotherapy has expanded in areas of extended scope of practice, and broader engagement with population needs beyond the individual treatment encounter. These changes raise increasingly complex ethical challenges evidenced by growth in physiotherapy-based ethics studies and discussions. This paper examines how a broad cross section of Australian physiotherapists perceive, interpret, and respond to ethical challenges in their work contexts and how professional codes of conduct are used in their practice. Using an interpretive qualitative methodology, purposive sampling of 88 members of national clinical special interest groups were recruited for focus group discussions. Narrative-based and thematic data analysis identified ethical challenges as emerging from specific clinical contexts, and influenced by health organizations, funding policies, workplace relationships, and individually held perspectives. Five themes were developed to represent these findings: (1) the working environment, (2) balancing diverse needs and expectation, (3) defining ethics, (4) striving to act ethically, and (5) talking about ethics. The results portray a diverse and complex ethical landscape where therapists encounter and grapple with ethical questions emerging from the impact of funding models and policies affecting clinical work, expanding boundaries and scope of practice and changing professional roles and relationships. Codes of conduct were described as foundational ethical knowledge but not always helpful for "in the moment" ethical decision-making. Based on this research, we suggest how codes of conduct, educators, and professional associations could cultivate and nurture ethics capability in physiotherapy practitioners for these contemporary challenges.

Scarcity of resources and inequity in access are frequently reported ethical issues for physiotherapists internationally: an observational study

“…A small number of studies are being reported from culturally different areas of the world [ 10 – 14 ], but no previous study has determined the scope and nature of ethical issues in the physiotherapy profession worldwide. What we do know from existing research is that ethical issues are part of everyday physiotherapy practice across fields of the physiotherapy profession, causing moral distress for practitioners and affecting quality and outcomes of care [ 1 , 2 , 4 , 9 ]. This part of professional practice cannot be ignored, rather it needs to be understood to be addressed appropriately and effectively.…”

“…A small panel of American physiotherapy experts identified further important ethical issues for the profession included appropriate clinical competence, achieving informed consent and maintaining confidentiality, product endorsement, truth in advertising, overutilization of services and sexual misconduct by physiotherapists [ 6 ]. Over the last 20 years, studies from Canada, America, Europe and Australia have continued to report, and expand, on these themes with increased identification of issues of patient autonomy, multiple stakeholders and conflicts of interest in decision-making, diversity in patients’ cultural values and beliefs, business and productivity conflicts with patient-centred care, professional boundaries, and the physiotherapist’s role as advocate [ 2 , 3 , 5 , 7 – 9 ].…”

Self-evaluated ethical competence of a practicing physiotherapist: a national study in Finland

“…Physiotherapists need skills in clarifying their ethical values and professional moral obligations and in making decisions which are in the best interests of their patients [14,15]. In the European Qualifications Framework, by the European Commission (2008), ethical competence is described as an integral part of knowledge, skills and competence, and as essential for the development of responsibility and autonomy [16].…”

“…However, challenging ethical situations occur in everyday practice when working in different settings with a variety of patients having different ages, values and attitudes, backgrounds and health situations. It is also known that professionals are not very familiar with their ethical codes and how to use them in real situations [12,15,28]. They rarely use ethical knowledge, e.g.…”

Løgstrup’s thinking: a contribution to ethics in physiotherapy

“…The increased focus on practice-based ethics has challenged the role of normative principles and codes of conduct, and raised discussions on a wide range of issues, such as informed consent, theoretical frameworks, moral agency, the ethics of the 'other', students and moral judgment, as well as ethical decision-making and professional identity (Delany, 2005;Drolet and Hudon, 2015;Edwards, Delany, Townsend, and Swisher, 2011;Edwards et al, 2012;Hudon, Drolet, and Williams-Jones, 2015;Linker, 2005;Praestegaard and Gard, 2013). A recent study by Delany, Edwards, and Fryer (2019) explored how individual therapists perceived, interpreted, and responded to ethical issues.…”