A. Sturm1, C.E. Fryer2, I. Edwards3, R. Roth1,4
1Interuniversity College for Health and Development Graz, Castle of Seggau, Graz, Austria, 2University of South Australia, UniSA Allied Health and Human Performance, Adelaide, Australia, 3University of South Australia, UniSA Allied Health and Human Performance, Adelaide, Austria, 4University of Graz, Graz, Austria

Background: This study sought to understand the complexity of ethical challenges for physiotherapists around the globe, including the diversity of socio-cultural and political influences, to inform appropriate support and training for physiotherapists to be moral agents in their everyday practice.

Purpose: The primary aim of the study was to explore the type and frequency of ethical situations encountered by physiotherapists internationally. This paper focuses on the contextual understanding of ethical issues that participants provided in an open question at the end of the study.

Methods: An online survey was distributed using purposive and snowball sampling. The questionnaire was developed in the English language. It contained 60 items in three sections:13 items requested participant sociodemographic details, including two items asking participants their knowledge of ethical codes and decision-making. 46 items asked the frequency that participants experienced specific ethical issues in four categories based on their context:
(A) Physiotherapist and patient interaction,
(B) Physiotherapist and other health professionals including other physiotherapists,
(C) Physiotherapists and the system and
(D) Professional and economic ethical situations.
The last item (Q60) asked participants optionally to describe an ethical situation they had experienced which was not mentioned in the list. Two researchers coded all individual Q60 response content into 5 categories that explained the relationship of the content to the 46 original ethical situations listed in survey Q14-59. All new ethical situations found in Q60 responses were then coded thematically.

Results: 1.212 individuals from 94 countries took part in the survey and 354 responded to Q60. Within the 354 responses we identified 501 issues, allocated to 5 different categories: content matching with the original survey questions Q14-59 (175), content somehow related with Q14-59 (202), new issue not covered by Q14-59 (22), nothing more to add (76) and unrelated content (26). After removing blank and unrelated codes, 399 issues for further analysis remained. Over a quarter of the 399 issues related in varying extent to just three original ethical situations: ‘Physiotherapist aware of misconduct by other health professionals’, ‘Bullying or harassment of physiotherapist by other health professional(s) including other physiotherapists’ and ‘Conflict with another health professional about patient’s management’. There were 22 new ethical situations identified in the remaining responses that were summarized in four new contextual themes:
(1) Lack of regulatory and/or accreditation policy and infrastructure;
(2) Lack of recognition of role and position of physiotherapists in healthcare;
(3) Economic factors driving the conduct of practice; and
(4) Political threats.

Conclusion(s): Professional duties contained in codes of conduct become almost impossible for some physiotherapists to comply with in the contexts of the workplaces and systems in which they practice. The primacy of making profit drives much of this difficulty. More understanding is needed of what can be done to effectively support physiotherapists to be ethical practitioners in these challenging contexts across the globe.

Implications: (Future) Physiotherapists need support in developing resilience against systemic pressures hampering ethically safe practice. The profession also needs to take a societal focus to understanding what is needed to support ethical practice in all regions.

Funding, acknowledgements: The study received funding by the Government of Salzburg/Austria (Land Salzburg), Department Culture and Science

Keywords: Ethics, Contextual, Global

Topic: Professionalism & ethics

Did this work require ethics approval? Yes
Institution: University of South Australia; IERM University of Vienna
Committee: UniSA: Human Ethics Committee; IERM: Dr. Stefan Dinges
Ethics number: UniSA 201295; IERM Ethics Vote 2/2018

All authors, affiliations and abstracts have been published as submitted.

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