Moral Agency as Enacted Justice: A Clinical and Ethical Decision-Making Framework for Responding to Health Inequities and Social Injustice

Abstract

This is the second of 2 companion articles in this issue. The first article explored the clinical and ethical implications of new emphases in physical therapy codes of conduct reflecting the growing evidence regarding the importance of social determinants of health, epidemiological trends for health service delivery, and the enhanced participation of physical therapists in shaping health care reform in a number of international contexts. The first article was theoretically oriented and proposed that a re-thinking of ethical frameworks expressed in codes of ethics could both inform and underpin practical strategies for working in primary health care. A review of the ethical principle of "justice," which, arguably, remains the least consensually understood and developed principle in the ethics literature of physical therapy, was provided, and a more recent perspective-the capability approach to justice-was discussed. The current article proposes a clinical and ethical decision-making framework, the ethical reasoning bridge (ER bridge), which can be used to assist physical therapy practitioners to: (1) understand and implement the capability approach to justice at a clinical level; (2) reflect on and evaluate both the fairness and influence of beliefs, perspectives, and context affecting health and disability through a process of "wide reflective equilibrium" and assist patients to do this as well; and (3) nurture the development of moral agency, in partnership with patients, through a transformative learning process manifest in a mutual "crossing" and "re-crossing" of the ER bridge. It is proposed that the development and exercise of moral agency represent an enacted justice that is the result of a shared reasoning and learning experience on the part of both therapists and patients.

The Second Physical Therapy Summit on Global Health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases

“…These issues however are emerging in the physical therapy literature. Swisher (2011a and have proposed the capabilities approach as a framework for physical therapists to understand and address social inequity in the interest of social justice and moral agency. They propose the need for physical therapists to practice within an ethical framework in considering the health needs of their patients/clients.…”

Ethics teaching in rehabilitation: results of a pan-Canadian workshop with occupational and physical therapy educators

“…It aims to highlight the "inquiry task of the medical practitioner as crossing a bridge where, on one side, information about a case that is universal and shared by all or most patients is sought and, on the other, information that is unique to a particular patient is sought" [18]. Drolet and Hudon [19] also proposed a Quadripartite Ethical Tool that uses central contemporary ethical theories (deductive-universalist approach) and the values, virtues and ethical principles of the primary stakeholders in a given situation (inductive-particularist approach) to help PT students recognize and analyze ethical issues in their practice.…”

Practicing physiotherapy in Danish private practice: an ethical perspective

“…seeking to describe normative frameworks for how to identify and handle ethical issues in healthcare practice in general (for instance Aadland 2000;Driver, 2007;Beauchamp and Childress 2009;Duncan 2010), and in physiotherapeutic practice in particular (Purtilo and Haddad, 2002;Gabard and Martin, 2003;Swisher and Page, 2005;Purtilo et al, 2005). An increasing number of research articles relating to ethical issues in physiotherapy have been published (Purtilo, 2000;Cross and Sim, 2000;Swisher, 2002;Geddes et al, 2004;Greenfield, 2005;Finch et al, 2005;Poulis, 2007a;2007b;Delaney, 2007;Delany, 2008;Carpenter and Richardson, 2008;Kelly and MackayLyons, 2010;Delany et al, 2010;Edwards et al, 2011aEdwards et al, , 2011bPraestegaard and Gard, 2011;.…”