Ethics knowledge in physical therapy: a narrative review of the literature since 2000

Abstract

Objective: The purpose of this narrative review is to assess current physical therapy ethics knowledge by synthesizing literature published since 2000. Method: This review builds on an earlier analysis.6 A rigorous search of major databases (including Medline, CINAHL, and PubMed) was conducted using specific keywords and explicit inclusion and exclusion criteria. The final review included 27 peer-reviewed articles and three editorials/lectures. Results: Four themes of papers were identified that focused on (1) development of physical therapy ethics knowledge, (2) ethical issues related to conducting research, (3) how ethical issues are identified and managed and how ethical practice is taught, and (4) development of theoretical ethical decision-making models. Discussion: The literature reflects a steady growth in interest in physical therapy ethics. Some 'gaps' in knowledge have been addressed but others have not, such as the impact of the institutional environment and cultural dimensions of practice on ethical reasoning. Research studies, using mostly qualitative approaches, identify similar issues but a synthesis of the findings is made difficult by lack of consistency in purpose and study design. While inclusion of ethics content in physical therapy curricula is recommended, little is known about how this is currently being achieved. Ethical theories are poorly integrated into the discussion of ethics in practice. Conclusion: This review reveals the continuing need to ensure the development of physical therapy ethical knowledge by consistently incorporating both ethical theories and practice knowledge in education curricula and establishing a rigorous research agenda that accurately reflects the unique and multidimensional nature of clinical practice.

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

“…Most of the findings about specific topics to be discussed in class aligned with those presented in the rehabilitation ethics literature [2,27]. In addition, some less frequently discussed topics were also brought to light by the CREW day participants, such as the ethics of teamwork in rehabilitation [28], the ethics of risks for patients [29] and the scope of ethical responsibility for the therapist.…”

“…For rehabilitation students and professionals, ethics skills and competencies are important tools to guide practice in the face of numerous challenges encountered when caring for their patients [2].…”

“…Multiple studies have reported ethical issues and challenges experienced by OT and PT students and professionals in their practice [2,9,10], but to our knowledge, very few international or national rehabilitation-related organization (e.g., OT or PT professional association) have proposed a set of detailed key ethics topics or specific guidance about what content should be included in ethics teaching to rehabilitation students [11-13, 4, 3]. In fact, the Entry-to-practice physiotherapy curriculum: content guidelines for Canadian university programs appears to be the only normative document providing a certain amount of guidance for programs concerning ethics teaching [3].…”

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;.…”

“…They are embedded in every clinical encounter, reasoning process and practice (Carr 2000;Purtilo and Haddad, 2002;Sandström 2007). Obvious ethical issues in physiotherapy are the handling of the given asymmetry of power (Thornquist, 2010), the strive of how to benefit patients (Delany et al, 2010;Praestegaard and Gard, 2013) and the inadequacies of professional argumentation when faced with ethical issues (Swisher, 2002;Carpenter and Richardson, 2008;Greenfield and Jensen, 2010;Delany et al, 2010;Lattanzi and Pechak, 2011;Delany and Frawley, 2012). 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).…”