EXPLORING THE INFLUENCES ON ETHICAL DECISION-MAKING IN PHYSIOTHERAPY PRACTICE

A. Lim¹, V. Xafis², C. Delany^3,4

¹Singapore Institute of Technology, Health and Social Sciences, Singapore, Singapore, ²University of Melbourne, Graduate School of Humanities and Social Sciences, Melbourne, Australia, ³University of Melbourne, Department of Medical Education, Melbourne, Australia, ⁴Royal Children's Hospital, Children's Bioethics Centre, Melbourne, Australia

Background: Culture and context play prominent roles in how we view, comprehend, and construct ourworld. However, much of the ethics knowledge in healthcare practice is grounded in Western models and cultures with little consideration of alternative cultures, values, and contexts. With greater ethical literacy, healthcare professionals are recognising the heightening significance of societal and organisational influences on ethical clinical practice. Much of physiotherapy research has focused on either the ethical issues encountered or the prescriptive models for ethical decision-making, with little research on the factors that influence the ethical encounters and the physiotherapist’s ethical decision-making. This research focused on the interface between the Asian context, the health discipline of physiotherapy and ethical decision-making.

Purpose: To explore the factors that influenced ethical issues in clinical practice and ethical decision-making, as interpreted by physiotherapists in Singapore.

Methods: Qualitative methods informed by interpretivism and phenomenology were employed. Data regarding the ethical issues encountered and the factors that influenced their ethical decision-making were collected through in-depth interviews with 42 physiotherapists practising in four different healthcare settings in Singapore. Inductive content analysis was used to analyse the interview transcript data.

Results: Western ethical tradition and educational models of ethical decision-making have overly emphasized a rational, linear model based on a principlism approach, neglecting the influence of individual characteristics, emotions, and social contexts. The findings revealed that the physiotherapist’s ethical decision-making is a complex, contextually dependent process, influenced by a multitude of interacting explicit and implicit factors residing in the micro, meso and macro spheres of ethics. In the micro sphere, the influences are related to the therapist’s individual values, needs, and experiences. In the meso sphere, the influences came from organisational culture, expectations, and validation. In the macro sphere, these influences centred around sociocultural beliefs, systems, and policies. For example, Singapore remains primarily a family-orientated, collectivist society, where the approval and support from the patient’s family can critically influence ethical decisions. A further classification that emerged inductively was explicit influences that were tangible, and implicit influences which were often implied and understood through personal experience or subjective interpretation.

Conclusions: There is a need for greater exploration of sociocultural and political influences on the ethical practices of physiotherapists. This is the first study specifically looking at the influences of ethical decision-making in physiotherapy clinical practice in an Asian context. The empirical data affirms current literature that ethical encounters and decision-making are shaped by interacting contextual factors and cannot be separated from the values and beliefs held by the physiotherapist.

Implications: Identifying the contextual factors that influenced physiotherapists as moral agents and acknowledging the influence of these internal and external constraints on ethical decision-making will allow the physiotherapy community to be aware of and understand the barriers to ethical practice. Addressing these issues and supporting physiotherapists are all needed in order not to have them leave the profession due to burnout or moral distress. More must be done to guide physiotherapists in addressing and overcoming these ethical challenges beyond just universal moral theories and codes of conduct.

Funding acknowledgements: This study was completed with support from the Singapore Institute of Technology (SIT) SEED grant (R-MOE-E103-C019).

Keywords:
ethical decision-making
context
physiotherapy

Topics:
Professionalism & ethics
Professional issues
Professional practice: other

Did this work require ethics approval? Yes

Institution: University of Melbourne/ Singapore Institute of Technology

Committee: Medicine and Dentistry Human Sub-Committee / Institutional Review Board

Ethics number: ID 1955123/ Project 2019146