Morality and Ethics in Physiotherapy Profession

As health care is considered divine and moral activity, physiotherapy professionals too are held to moral standards with expectations of ethical conduct.

1. Dr Sreeraj S R, Ph.D. CONCEPT OF MORALITY AND ETHICS IN PHYSIOTHERAPY

2. 2 Morality refers to the set of standards or principles derived from a code of conduct from a particular philosophy, religion, or culture to enable people to live cooperatively in groups. It’s what societies determine to be “right” and “acceptable.” Morality ?

3. Ethics derives from, the Greek word “ ethicos ” which means arising from custom . Ethics is a branch of philosophy that “involves systematizing, defending, and recommending concepts of right and wrong behavior.  Legal guidelines and professional rules govern ethics. The acceptability of ethics is confined within a particular space and time frame. Ethics ? 3

4. 4 Morality vs Ethics Morality Personal, seen from the perspective of an individual. Individual’s own principles regarding right and wrong. Religious connotation. Ethics can be violated by a moral person to maintain / uphold his moral values. Rules provided by an external source Implemented by business, law, medicine, profession etc. No religious connotation. Dependent on the prism of others. Ethics

5. 5 The four pillars of medical ethics are: Beneficence (doing good) Non-maleficence (to do no harm) Autonomy (giving the patient the freedom to choose freely, where they are able) Justice (ensuring fairness) BioMedical Ethics

6. 6 Example: An eight-year-old child has been admitted to hospital with a significant open fracture to his left leg. The limb is deformed with significant bleeding and the patient is extremely distressed. The parents are demanding immediate action to be taken. Is amputation a treatment option? Beneficence

7. 7 Example: A 52-year-old man collapses in the street, complaining of severe acute pain in his right abdomen. A surgeon who is passing by examines the man, suspecting that he is on the brink of rupturing his appendix. The surgeon decides the best course of action is to remove the appendix in situ, using his trusty pen-knife. Do you think the surgeon’s actions are in beneficence or maleficence to the patient? Non-maleficence

8. 8 Example: A 26-year-old male has been involved in an RTA, in which he sustained blunt force trauma to his head. He is fully responsive and has no indications of neurological damage. He does, however, have a significant head wound that is bleeding continuously. This patient has refused treatment because he feels “fine” and is refusing to have sutures to close his head wound. He would like to leave the Department. Will the hospital allow to leave him? Autonomy

9. 9 Example: In a particular hospital, patients suspected of having cancer are prioritized based on their ability to pay for the expensive treatment, with the maximum waiting time for referral being two weeks as opposed to 18 weeks for non-urgent referrals.  Do you think the right to equal treatment is not respected here? Justice

10. 10 When a patient gives permission before receiving any form of medical treatment, examination, or test. It means that the patient has agreed to what is about to happen to them. Three criteria are met: It is voluntary. It is informed. The patient has capacity. Medical Consent

11. 11 Medical consent is given in two major ways: Verbally. Example: A “Yes” response from the patient to the practitioner’s question “Shall I proceed with the test? Written. For example, a patient signs a surgery consent form.

12. 12 If the patient cannot give a consent Emergency life-saving treatment such as being unconscious, during an operation. The patient has a severe mental health condition. If there is a wider risk to public health if the patient goes untreated. Extremely ill, unhygienic, and living in poor conditions. When Is Consent Not Needed?

13. 13 Consent may only be given by individuals who have reached the legal age of consent. Assent is the agreement of someone not able to give legal consent to participate in the activity.   18-year-olds are to be treated like all other adults. For children between 7 and 11 years of age, oral assent must be got in the parent’s presence. For children between 12 and 18 years of age, written assent must be got. Consent vs Assent

14. 14 Consequentialism Utilitarianism Deontology Medical Ethics Concepts

15. 15 A consequentialism ideology supports that lying in a particular circumstance is acceptable, even though lying itself is not a moral action. Example:  Your patient has a terminal illness and is not likely to survive the operation she is about to undertake. Just as she is about to be anaesthetized, she asks you: “Doctor, will I be okay?” Consequentialism

16. 16 Utilitarianism holds that the most ethical choice is the one that will produce the greatest good for the greatest number. Example:  You have a sum of money to either fund a very expensive treatment for one patient with a rare disease or five patients with a very common and easy-to-treat disease. Utilitarianism

17. 17 Focuses on rules and duties, not consequences or character. This is in direct contrast with consequentialism. Example:  If your terminally ill patient asks if they’ll be ok after a surgery, they’re unlikely to survive, Just as she is about to be anaesthetized, she asks you: “Doctor, will I be okay?” Deontology

18. 18 According to Sigmund Freud, the id is the primary component of personality. It is the only component of personality that is present from birth. It is entirely unconscious and includes instinctive and primitive behaviors. The id is driven by the pleasure principle Example Trying to convince an infant to wait until lunchtime to eat their meal. The id requires immediate satisfaction, and the infant will cry until these needs are fulfilled. Id

19. 19 It is striven to satisfy the id's desires in realistic and socially appropriate ways. It is driven by Reality Principle The term ego is often used informally to suggest that. The ego in personality has a positive effect if someone has not an inflated sense of self. Example As the meeting progresses, you become more and more hungry. While the id compel you to rush to the break room for a snack, the ego guides you to sit quietly and wait for the meeting to end. Ego

20. 20 The superego holds the moral standards and ideals that we acquire from our parents and society i.e. our sense of right and wrong. The superego provides guidelines for making judgments. Example A student forgot to study for a history test and feels an urge to copy from a student sitting nearby. Even though he feels like the chances of getting caught are low, he knows that cheating is wrong, so he suppresses the urge. Super ego

21. 21 Read the content in the following link and then attend MCQ test shared in Google Classroom. https://www.themedicportal.com/application-guide/medical-school-interview/medical-ethics/ Test

22. 22 What Does Morality Really Mean? [Internet]. Verywell Mind. 2020 [cited 2023 Dec 16]. Available from: https://www.verywellmind.com/what-is-morality-5076160 Morality [Internet]. Wikipedia. Wikimedia Foundation; 2023 [cited 2023 Dec 16]. Available from: https://en.wikipedia.org/wiki/Morality Ethics [Internet]. Physiopedia . 2023 [cited 2023 Dec 16]. Available from: https://tinyurl.com/zr8e7yk5 Difference between Ethics and Morality & Their Comparisons [Internet]. BYJU’S; 2020 [cited 2023 Dec 16]. Available from: https://tinyurl.com/5dvn2sm3 Ethics vs Morals - Difference and Comparison [Internet]. Diffen.com.; 2023 [cited 2023 Dec 16]. Available from: https://www.diffen.com/difference/Ethics_vs_Morals Boag S.  Ego, drives, and the dynamics of internal objects.  Front Psychol. 2014;5:666. doi:10.3389/fpsyg.2014.00666 References

23. 23 THANK YOU