No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
The Role of Emotions in Ethical Decision Making: Implications for Physical Therapist Education
... However, a clear answer to this age-old puzzle remains elusive and to many, this phenomenon appears irrational and perplexing. Rational explanations as to why good people do bad (e.g., necessity or greed) are plentiful, but over-simplistic and fail to provide adequate answers (Greenfield 2007). It is evident that deliberative rational thought is insufficient to prevent normally moral people from acting immorally ( Gino et al. 2008). ...
... Moral blindness is rooted in emotions; it is the subjective experience of emotions that provide the contextual factors that promote moral blindness ( Palazzo et al. 2012). Emotions permeate almost every aspect of our lives and are foundational to morality (Gabriel and Griffiths 2002;Greenfield 2007;Lurie 2004). Research confirms the important influence of emotions on moral behavior and decisions (Bracht and Regner 2013). ...
... The tension between cognitions of right and wrong, conflicting with actual misaligned behavior or desires inevitably generates dissonance and intense negative affect, (Keggereis 2013;Tsang 2002), characterized by unwelcome and unpleasant emotions, such as disgust (with self), guilt, shame, and anxiety ( Barsade et al. 2009;Kitcher 2012;Velasquez 2011). Moral emotions generally refer to these emotions and emotional responses that alert one to a moral issue (Greenfield 2007;Wettergren 2010). In most circumstances, these emotions should activate self-sanctioning and correct or reverse unethical behavior toward being more ethical (Polman and Ruttan 2012). ...
Coaching is one of the fastest growing industries. However, ethical insights on coaching are not developing at the same rate. Even highly qualified coaches can find themselves involved in serious ethical issues, especially in a multi-cultural context. This chapter is a philosophical and normative analysis from a meta-theoretical literature review. Ethical issues are identified, questionable approaches in coaching psychology is critiqued and a model for ethical coaching in a multi-cultural context is developed under eight themes: coaching regulation, scientific foundation, normative issues, diagnostic assessments, confidentiality and conflicting interests, dependency, keeping coaching boundaries and coaching proficiency. Coaching ethically is complex and fraught with ethical issues that can easily be missed. Identification of the ethical issues in coaching psychology creates better understanding of potential ethical pitfalls and how to avoid them. This can lead to a more ethical, and thus sustainable coaching industry.
... However, a clear answer to this age-old puzzle remains elusive and to many, this phenomenon appears irrational and perplexing. Rational explanations as to why good people do bad (e.g., necessity or greed) are plentiful, but over-simplistic and fail to provide adequate answers (Greenfield 2007). It is evident that deliberative rational thought is insufficient to prevent normally moral people from acting immorally (Gino et al. 2008). ...
... Moral blindness is rooted in emotions; it is the subjective experience of emotions that provide the contextual factors that promote moral blindness (Palazzo et al. 2012). Emotions permeate almost every aspect of our lives and are foundational to morality (Gabriel and Griffiths 2002;Greenfield 2007;Lurie 2004). Research confirms the important influence of emotions on moral behavior and decisions (Bracht and Regner 2013). ...
... The tension between cognitions of right and wrong, conflicting with actual misaligned behavior or desires inevitably generates dissonance and intense negative affect, (Keggereis 2013;Tsang 2002), characterized by unwelcome and unpleasant emotions, such as disgust (with self), guilt, shame, and anxiety (Barsade et al. 2009;Kitcher 2012;Velasquez 2011). Moral emotions generally refer to these emotions and emotional responses that alert one to a moral issue (Greenfield 2007;Wettergren 2010). In most circumstances, these emotions should activate self-sanctioning and correct or reverse unethical behavior toward being more ethical (Polman and Ruttan 2012). ...
Although apparently irrational, people with seemingly high moral standards routinely make immoral decisions or engage in morally questionable behavior. It appears as if under certain circumstances, people become in some enigmatic way blind to the immoral aspects of what they are doing or consequences of their immoral actions. This article focuses and reports on a psychoanalytic inquiry into the role of emotions and the unconscious management of unwanted emotions in promoting moral blindness. Emotions are essential to the conscience, self-sanctioning, and advancement of moral behavior. Notwithstanding moral ideations, a sufficiently strong counterwill may create incongruence between moral intentions and actual desires or behavior. The unwelcome experience of acute moral emotions such as guilt and anxiety is likely to activate a range of psychological defense mechanisms and unconscious processes to manage these emotions. It is argued that the management of these emotions through undue avoidance, inappropriate regulation, or lack of regulation, can bypass self-sanctioning. As result, the condition of moral blindness can develop or be sustained. The psychoanalytic explanations offered contribute to the understanding as to how emotions in combination with the unconscious mind can cause moral blindness in any person, notwithstanding high moral standards and good intentions. Improved understanding of moral blindness represents an important scientific step in improved understanding of our moral and immoral selves, with all its complexities, conflicts, and contradictions.
... Additionally, the consultation of professional associations and regulatory bodies has been reported to gather information or finding answers to their ethical questions. Greenfield [36] from the United States early on challenged the idea of ethical decision-making as being a rational process only. He outlined the importance of affective aspects and the role of emotions in ethical decisions, which he suggested should be acknowledged in physiotherapy education. ...
... Doing justice to physiotherapists' complex, interrelated, multidimensional and context-dependent realities of ethical decision-making requires making current and future physiotherapists familiar with a broad spectrum of ethical theories and decision-making frameworks. Several scholars in physiotherapy ethics -located in both individualistic and communitarian/collectivist societiessuggest including approaches into professional ethics education that acknowledge both individual situatedness and interrelatedness, physiotherapists' social/societal responsibilities, foster mutual understanding, and recognise the value of own perceptions such as intuition, emotions, as well as of reflective practice [3,4,15,30,31,33,36,81]. On the basis of the weight that our study's results put on the findings of studies and theoretical considerations of other ethicists in physiotherapy, we echo such claims. ...
Background
There is a lack of knowledge about factors that play a role in ethical decision-making of physiotherapists internationally. The purpose of this study was to explore, describe and map factors in ethical decision-making of physiotherapists from around the globe.
Methods
A descriptive research design and constructivist research paradigm was applied. Elements of both a coding reliability thematic analysis and a reflexive thematic analysis method were used deductively and inductively to analyse the content of responses to an optional open question in an internationally distributed online survey with 559 participants from 72 countries through several steps and cycles.
Results
A spectrum of 43 factors was identified within 200 individual responses, allocated to five themes: individual factors (19 factors); relational factors (6 factors); organisational factors (6 factors); situational factors (6 factors); and societal factors (6 factors). The importance of context on organisational, situational and societal levels, interrelatedness of physiotherapists, individual characteristics and situatedness of patients/clients and physiotherapists, as well as aspects and features of the patient/client-physiotherapist relationship became apparent throughout analysis.
Conclusions
To meet the emerging requirements for ethical physiotherapy practice, we advocate that both physiotherapy students and practicing physiotherapists internationally need to be trained as moral agents in integrated manners. Based on the results of this study we conclude that such training should embrace professionalism, professional values, ethical codes, ethical theories and ethical decision-making frameworks that acknowledge interrelatedness, epistemology and situatedness, self-reflective and communicative techniques, critical thinking, social/societal determinants of health, social responsibility, cultural competence and self-care techniques.
... Ethical issues are imbedded in every clinical meeting. However, ethical reasoning models have implied linear progression, characterized by dis-crete and step-by-step decision making [8]. Callahan argued that the context of making an ethical decision could be complex. ...
... The conflict between personal and professional values may result in emotional perturbations. Such issues could influence physiotherapists' ethical behavior, including their moral motivation to manage the patients [8]. ...
Objectives: Considering the significant role of physiotherapists in the process of rehabilitation, their ethical commitment is essential to successful interaction and care provision. However, investigations on the medical professional ethics in Iran are limited. Generally, research in this regard is rare in Asia. Thus, such studies could improve the moral knowledge of the Iranian physiotherapy community. Accordingly, this study aimed to explore professional ethics issues in physiotherapy to provide a platform concerning the challenges of professional ethics in physiotherapy in Iran. Methods: This qualitative study was conducted in 2016-2017 using the content analysis method. The study samples were recruited through purposive sampling approach until data saturation (12 physiotherapists). The required data were gathered by an in-depth semi-structured interview. All of the interviews were transcribed and analyzed, inductively. Results: Physiotherapists in Ahvaz and Tehran cities, Iran experienced challenges in 6 different categories during daily practice. These aspects included the following: therapists’ self-interest-craving, observing patients’ rights, maintaining professional competence, the effect of workplace on ethical conduct, personal ethical outlook, and insufficient professional ethics education. This study implicated the existence of a trend of kick-backs in the physiotherapy community; a problematic trend in the medical community, i.e. addressed by physicians in several articles. Additionally, the lack of receiving ethical education leads to ethical judgments based on personal values rather than ethical codes. According to the current research findings, it To increase the visibility of the article as well as to increase the citation of your article, we suggest that Latin keywords be based on the MeSH list. See: https://meshb.nlm.nih.gov/search was problematic for practitioners. Discussion: Three subcategories of the incompetence of the healthcare system, the lack of supervision on ethical principles, and the impact of poor insurance system on patient admission are related to the endemic conditions of the health system of the country. These issues require serious interventions from executive powers.
... Coughlan and Connolly (2008) extended the Rest (1986) model, and addressed the role of emotions which were shown to be an important part of the decision process. Greenfield (2007) posits that "…emotional responses to moral issues and dilemmas often influence our moral sensitivity and moral judgment and often motivate moral behavior." (2007, 15) We continue their research to explore the effects of emotions on moral judgment and intention to whistleblow using a sample of 220 professional accountants and four earnings management scenarios. ...
... Guadine and Thorne (2001) Using the Rest (1986) model, Greenfield (2007) reported that the role of emotions affects ethical decision making in certain moral dilemmas. He reported that "all emotions are responses to perceived changes, threats, and opportunities that may alert us to a moral issue" for a selected group of physical therapists (2007,15). ...
Unethical earnings management continues to exist. Pressures to meet analysts‟
expectations and to improve the bottom line are commonplace. While certain techniques are
legal and ethical in managing earnings, it is easy to approach and descend the slippery slope
between ethical and unethical behavior (Stice and Stice, 2006). For example, timing of
advertising and other period costs to increase or decrease net income during a year is prudent and
acceptable. But to make accounting changes without appropriate disclosures, to purposefully
capitalize ordinary expenses, or to intentionally alter the year-end cutoff for purposes of
managing earnings are violations of GAAP. The latter two actions, if there is harm, are
fraudulent. Is it possible that reporting of wrongdoing may be avoided or decrease the effect of
accounting scandals that resulted from inappropriate earnings management?
A significant stream of research has used Rest‟s (1986) model of moral action (described
below) to explore the ethical decision making of accountants. Coughlan and Connolly (2008)
extended the Rest (1986) model, and addressed the role of emotions which were shown to be an
important part of the decision process. Greenfield (2007) posits that “…emotional responses to
moral issues and dilemmas often influence our moral sensitivity and moral judgment and often
motivate moral behavior.” (2007, 15) We continue their research to explore the effects of
emotions on moral judgment and intention to whistleblow using a sample of 220 professional
accountants and four earnings management scenarios. We find that relief, satisfaction, and regret
do have a certain effect on moral judgment, but not on whistleblowing intention.
* The authors are, respectively, Professor of Accounting at Florida Southern College, and Professor of Accounting at
King‟s College.
Journal of Forensic & Investigative Accounting
Vol. 7, Issue 1, January - June, 2015
147
The remainder of this paper is divided into the following four sections. The literature
review section provides a theoretical foundation for the study, discussions on earnings
management and emotions, and the hypotheses. The next section provides the methodology of
the study. In the third section, the results are provided with discussion. The fourth section reports
our conclusions, some of the limitations of the study, and suggestions for further research.
The entire article can be downloaded at the Journal of Forensic & Investigative Accounting website at http://web.nacva.com/JFIA/Issues/JFIA-2015-1_6.pdf
... 3,7 Everyday, physical therapists confront ethical issues in their practice. [8][9][10] In response, academic faculties in physical therapy education have focused on education of physical therapists to be ethically engaged practitioners. [11][12][13][14] To be ethically engaged is to be committed to ethically care for patients mindful of their needs, values and goals, attuned to their illness experiences, and emotionally open to their suffering. ...
... There is ongoing evidence that more and more, physical therapists are being exposed to situations that result in moral distress, ethical dilemmas, conflict in locus of authority, or involve legal issues. [8][9][10] As our responsibilities in patient care expand (direct access), we are facing and will face situations of increasing complexity involving a greater number of stakeholders, with multiple viewpoints, and greater extremes of emotional responses. We must teach and prepare student to be morally and ethically engaged to reason through emotionally laden 'minefields'. ...
This article questions our basic assumptions and approaches to ethics education in the health professions. Across the health professions, there is increased need for health professionals to carry out their moral duties in individual patient care, as well as collaborate, as part of an interprofessional team that is grounded in a sense of purpose to the common good in health care. We believe that to be ethically engaged is to be committed to ethically care for patients mindful of their needs, values and goals, attuned to their illness experiences, and emotionally open to their suffering. Students need to be skilled in ethical reasoning and decision-making as a core element of professional competence. In this article we use a model of pedagogical reasoning and action to uncover the critical teaching and learning issues that are part of facilitating students’ development of habits of mind and ethical competence. We further argue that the tools phenomenology, narrative thinking and the development of meta-cognitive skills are fundamental parts of the pedagogical content knowledge that is essential in teaching and learning in ethics.
... Moral dissonance arises when the tension between cognitions of right and wrong conflicts with actual misaligned behavior or desires, thus generating the experience of unpleasant emotions, such as guilt, shame, and anxiety (Barsade et al., 2009;Kitcher, 2012;Velasquez, 2011). Moral emotions are emotional responses that alert one to a moral issue (Greenfield, 2007;Wettergren, 2010), and should activate self-sanctioning in order to correct immoral behavior toward being more ethical (Polman & Ruttan, 2012). However, in the case of moral blindness, this does not happen (de Klerk, 2017). ...
The purpose of this study was to empirically test the proposition that contagion of emotions triggers moral disengagement and subsequent increases in work-related injuries. Using emotional contagion and social cognitive theories, we tested the proposition that higher contagion of anger (i.e., a negative emotion that interferes with mental functioning and enables inappropriate behavior) would trigger moral justifications for safety violations, whereas higher contagion of joy (i.e., a positive emotion accompanied by an optimal operating condition and constructive activity) would prevent safety-related moral disengagement. In turn, moral disengagement was predicted to be related to higher rates of subsequent workplace injuries. Using a cross-country and multi-method (i.e., cross-lagged, cross-sectional) design, data from 503 employees in the U.S. (two-wave) and 538 employees in Italy (cross-sectional) supported the hypothesized mediation model. Specifically, both in the U.S. and Italy, emotional contagion of anger positively predicted moral disengagement, whereas emotional contagion of joy negatively predicted moral disengagement. Furthermore, moral disengagement positively predicted experienced injuries and partially mediated the relationship between contagion of joy/anger and injuries. These findings suggest that moral justifications of safety violations, and related injuries, may be prevented by exchanges of positive emotions (and triggered by exchanges of negative emotions) that employees absorb during social interactions at work. Theoretical and practical implications for organizational ethics are discussed in light of the globally increasing emotional pressure and concerns for a safe and psychologically healthy environment in today’s workplace, particularly given the recent pandemic spread of Coronavirus disease (CoVid-19).
... Therefore, they are involved in the ethical decision-making process, which is essentially a cognitive process where emotions are bound by logic. What matters in this process is to ensure the harmony between the heart and brain (Callahan 2000, Greenfield 2007, and it is possible to speak of four fundamental concepts that are deemed to be important at this point. ...
Nursing is an interdisciplinary field that aims to assist individuals, families and society without causing any harm stemming from malpractice, negligence or abuse and to comply with the ethical principles governing the profession, while making contributions to the promotion of health and the prevention of diseases (Silva et al. 2018). Therefore, taking an active role concerning diseases, care and treatments while touching the lives of individuals, nurses have a significant place both for patients and society (Scott 2017).
Considering the history of nursing, it is possible to see “ethics” and “ethical assessment” as the basis underlying the development of the nursing profession as well as the foundations of the nursing practices. In this context, ethical assessment and practices are necessitated by the fact that nurses are supposed to show empathy towards and meet the needs of the suffering individual. Values of every nurse, which she/he bases entirely on her/his ethical assessments and experiences, contribute to the ethical development of that specific nurse (Burkhardt and Nathaniel 2013).
Ethics deals with “what should be done and what should be prevented”. Furthermore, for care and treatments, it focuses on the things that are beneficial for the patient. (Elçigil et al. 2011, Temiz et al. 2017). Besides, it helps us comprehend how to reach our potential as human beings, while analyzing how an individual might approach the decisions on how they can behave in a specific situation. Thus, ethics is an active process rather than a static one, that is why emotional expressions are involved in ethical practices. However, emotions and feelings, which are a part of daily life, bring along ethical problems in professional practices (Buts and Rich 2016). This situation is quite apparent in the nursing profession. Because there is a reciprocal interaction in cognitive, emotional and behavioral areas between, on the one hand, the nurses, who are at the heart of the care and treatment, and on the other hand the patients. Hence, ethical problems might become unavoidable in cases where there are misunderstandings in the nurse-patient interaction (Husted et al. 2015).
... Our analysis of participants' stories highlighted that they were actively engaged in grappling with ethical questions of how to best meet the needs of their clients. In this research, acting ethically and reflecting about ethical aspects of practice were described as relational, emotional, and contextbound activities (Gillam, Delany, Guillemin, and Warmington, 2013;Greenfield, 2007) involving individuals, colleagues, and organizations. They were not described as a cognitive process of weighing up and applying ethical theories and principles to particular decisions (Bergum and Dossetor, 2005). ...
The profile and reach of physiotherapy has expanded in areas of extended scope of practice, and broader engagement with population needs beyond the individual treatment encounter. These changes raise increasingly complex ethical challenges evidenced by growth in physiotherapy-based ethics studies and discussions. This paper examines how a broad cross section of Australian physiotherapists perceive, interpret, and respond to ethical challenges in their work contexts and how professional codes of conduct are used in their practice. Using an interpretive qualitative methodology, purposive sampling of 88 members of national clinical special interest groups were recruited for focus group discussions. Narrative-based and thematic data analysis identified ethical challenges as emerging from specific clinical contexts, and influenced by health organizations, funding policies, workplace relationships, and individually held perspectives. Five themes were developed to represent these findings: (1) the working environment, (2) balancing diverse needs and expectation, (3) defining ethics, (4) striving to act ethically, and (5) talking about ethics. The results portray a diverse and complex ethical landscape where therapists encounter and grapple with ethical questions emerging from the impact of funding models and policies affecting clinical work, expanding boundaries and scope of practice and changing professional roles and relationships. Codes of conduct were described as foundational ethical knowledge but not always helpful for “in the moment” ethical decision-making. Based on this research, we suggest how codes of conduct, educators, and professional associations could cultivate and nurture ethics capability in physiotherapy practitioners for these contemporary challenges.
... A globalised, transcultural workforce does not automatically generate intercultural understandings. Within this ethnocentric context of unrecognised cultural morés, negative moral emotions such as guilt, disgust, contempt and anger are readily aroused (Greenfield, 2007). These complexities underscore why appropriate role models are essential to guide educated moral emotions in practice. ...
Moral emotions shape the effectiveness of culturally diverse teams. However, these emotions, which are integral to determining ethically responsive patient care and team relationships, typically go unrecognised. The contribution of emotions to moral deliberation is subjugated within the technorational environment of healthcare decision-making. Contemporary healthcare organisations rely on a multicultural workforce charged with the ethical care of vulnerable people. Limited extant literature examines the role of moral emotions in ethical decision-making among culturally diverse healthcare teams. Moral emotions are evident in ethnocentric moral perspectives that construct some colleagues’ practices as ‘other’. This article examines how moral emotions are evoked when cultural dissonance influences nurses’ moral perceptions. We use a qualitative investigation of teamwork within culturally diverse healthcare organisations. We use Haidt's (2003) account of moral emotions to examine practice-based accounts of 36 internationally educated and 17 New Zealand educated nurses practising in New Zealand. The study provides evidence that moral emotions are frequently elicited by communication and care practices considered ‘foreign’. The main implication is that although safe practice in healthcare organisations is reliant on highly functioning teams, collaboration is challenged by interprofessional power relations of contested culturally shaped values. We address practice-based strategies that enable engagement with moral emotions to enhance effective teamwork.
... At the least, according to Etzioni, our values and emotions significantly shape our choices. Greenfield (2007) extends Rest's (1986) work describing a conceptual model of factors that influence moral behavior, shown in Figure 1. Greenfield identifies that "all emotions are responses to perceived challenges, threats, and opportunities that may alert us to a moral issue….emotional ...
... At the least, according to Etzioni, our values and emotions significantly shape our choices. Greenfield (2007) extends Rest's (1986) work describing a conceptual model of factors that influence moral behavior, shown in Figure 1. Greenfield identifies that "all emotions are responses to perceived challenges, threats, and opportunities that may alert us to a moral issue….emotional ...
There is a significant amount of research and models on ethical decision-making processes; however, there is limited research on how emotions affect ethical evaluations and decisions in an accounting context. Prior research suggests that emotions may shape ethical evaluations and choices made by individuals. This study contributes to the accounting literature by exploring the emotions an accountant may feel when evaluating earning manipulations. This study finds that accountants feel regret when evaluating earnings manipulations.
Full-text can be found at http://www.bus.lsu.edu/accounting/faculty/lcrumbley/jfia/Articles/v4n1.htm
... Simulations or standardized patients provide learning opportunities for novices to interact with simulated patients or real patients in a clinical situation, experience emotions in a safe environment and then reflect on their experiences in their own words. 58,59 Reflection on emotions emphasizes the relationship between a student's behaviors or words that begin or trigger an emotional response. By openly acknowledging that different emotions are evoked in different circumstances, novices have an opportunity to reflect on their emotional repertoire in a way that is encouraging and safe. ...
This perspective article provides a justification, with an overview, of the use of phenomenological inquiry and the interpretation into the everyday ethical concerns of patients with disabilities. Disability is explored as a transformative process that involves physical, cognitive, and moral changes. This perspective article discusses the advantages of phenomenology to supplement and enhance the principlist process of ethical decision making that guides much of contemporary medical practice, including physical therapy. A phenomenological approach provides a more contextual approach to ethical decision making through probing, uncovering, and interpreting the meanings of "stories" of patients. This approach, in turn, provides for a more coherent and genuine application of ethical principles within the "textured life-world" of patients and their evolving values as they grapple with disability to make ethical and clinical decisions. The article begins with an in-depth discussion of the current literature about the phenomenology of people with disability. This literature review is followed by a discussion of the traditional principlist approach to making ethical decisions, which, in turn, is followed by a discussion of phenomenology and its tools for use in clinical inquiry and interpretation of the experiences of patients with disabilities. A specific case is presented that illustrates specific tools of phenomenology to uncover the moral context of disability from the perspective of patients. The article concludes with a discussion of clinical, educational, and research implications of a phenomenological approach to ethics and clinical decision making.
... Rather, our emotions need to be fully developed to enter into moral discourse, 67 and positive examples of the emotions in physical therapist practice are available in the physical therapy literature. 25,41,68,69 The compassionate physical therapist knows the patient's narrative and is emotionally moved to "do what (he or she) must" 66 to relieve the patient's suffering. ...
Constrained practice is routinely encountered by physical therapists and may limit the physical therapist's primary moral responsibility-which is to help the patient to become well again. Ethical practice under such conditions requires a certain moral character of the practitioner. The purposes of this article are: (1) to provide an ethical analysis of a typical patient case of constrained clinical practice, (2) to discuss the moral implications of constrained clinical practice, and (3) to identify key moral principles and virtues fostering ethical physical therapist practice.
The case represents a common scenario of discharge planning in acute care health facilities in the northeastern United States.
An applied ethics approach was used for case analysis.
The decision following analysis of the dilemma was to provide the needed care to the patient as required by compassion, professional ethical standards, and organizational mission.
Constrained clinical practice creates a moral dilemma for physical therapists. Being responsive to the patient's needs moves the physical therapist's practice toward the professional ideal of helping vulnerable patients become well again. Meeting the patient's needs is a professional requirement of the physical therapist as moral agent. Acting otherwise requires an alternative position be ethically justified based on systematic analysis of a particular case. Skepticism of status quo practices is required to modify conventional individual, organizational, and societal practices toward meeting the patient's best interest.
Background and purpose:
The traditional domains of learning are cognitive, psychomotor, and affective. These parallel the habits of head, hand, and heart as the foundations for knowing, doing, and being in health professions education. Physical therapy education is deeply rooted in a cognitive (head) and psychomotor (hand) taxonomy despite the mission, vision, and values of the profession that embody the knowledge, skills, and attitudes (KSAs) requiring competence in the affective (heart) domain. Recently, the Model for Excellence and Innovation in Physical Therapy Education and the American Council of Academic Physical Therapy excellence framework in academic physical therapy identified pedagogical variables grounded in the affective domain (AD), including shared beliefs and values, partnerships and collaborations, leadership and innovation, social responsibility and inclusion, and a drive for excellence with high expectations.
Position and rationale:
Fully integrating the AD into physical therapy education equips the future of the profession with the KSAs to achieve the mission and vision, meet stakeholder needs, and endure the demands of clinical practice.
Discussion and conclusion:
Explicitly using the AD in physical therapy education is imperative to the success and sustainability of the profession and in meeting critical societal needs. Engaging all learners in the AD does not require monumental curricular change. Intentional activities and strategies can develop the humanistic values of the learner across a curriculum and can shift the culture of academia from primarily cognitive and psychomotor to one that is comprehensive across all domains. The AD informs the cognitive and psychomotor aspects of learning and has direct implications for clinical practice in meeting stakeholder needs.
Purpose:
The purpose of this case report is to explore the active engagement model as a tool to illuminate the ethical reflections of student physical therapists in the context of service learning in a developing country.
Methods:
The study participants were a convenience sample of six students. The study design is a case report using a phenomenological perspective. Data were collected from students' narrative writing and semi-structured interviews. The steps of the active engagement model provided the structural framework for student responses. The analysis process included open coding, selective coding, and member checking.
Results:
Results showed the emergence of two main themes: 1) gathering rich detail and 2) developing independent moral identity. Students' descriptions of their relationships were detailed and included explanations about the complexities of the sociocultural context. Independent and deliberate agency was evident by the students' preparedness to be collaborative, to raise ethical questions, to identify ethically important aspects of their practice and to describe their professional roles. The students noted that the use of the model increased their engagement in the ethical decision-making process and their recognition of ethical questions.
Conclusions:
This case report illustrates attributes of the active engagement model which have implications for teaching ethical reflection: scaffolding for ethical reflection, use of narrative for reflection, reflection in action, and illumination of relevant themes. Each of these attributes leads to the development of meaningful ethical reflection. The attributes of this model shown by this case report have potential applications to teaching ethical reflection.
Prior research suggests that evaluating employee reactions can help understand the human costs of unethical behavior. However, there is limited research exploring emotional reactions to unethical behavior and no studies that explore emotional reactions when financial statement fraud occurs. In an attempt to fill a gap in the literature, the purpose of this study is to explore whether practicing accountants feel certain negative emotions when asked by a member of management to manipulate earnings. We find that practicing accountants feel emotions of anger, disappointment, and regret when asked by a member of management to complete an action that results in financial statement fraud. The implications of these findings are discussed.
Physical therapy, like all health-care professions, governs itself through a code of ethics that defines its obligations of professional behaviours. The code of ethics provides professions with a consistent and common moral language and principled guidelines for ethical actions. Yet, and as argued in this paper, professional codes of ethics have limits applied to ethical decision-making in the presence of ethical dilemmas. Part of the limitations of the codes of ethics is that there is no particular hierarchy of principles that govern in all situations. Instead, the exigencies of clinical practice, the particularities of individual patient's illness experiences and the transformative nature of chronic illnesses and disabilities often obscure the ethical concerns and issues embedded in concrete situations. Consistent with models of expert practice, and with contemporary models of patient-centred care, we advocate and describe in this paper a type of interpretative and narrative approach to moral practice and ethical decision-making based on phenomenology. The tools of phenomenology that are well defined in research are applied and examined in a case that illustrates their use in uncovering the values and ethical concerns of a patient. Based on the deconstruction of this case on a phenomenologist approach, we illustrate how such approaches for ethical understanding can help assist clinicians and educators in applying principles within the context and needs of each patient.
Although there is extensive literature in other health care fields about the ability to make ethical judgements (moral reasoning), there is a paucity of research addressing the moral reasoning of practising physical therapists. The purposes of this research were to 1) identify the types of moral reasoning used by practising physical therapists as measured by the Defining Issues Test; 2) identify differences in moral reasoning among physical therapists based on educational background, demographic variables, clinical experience, practice setting or expertise in ethics; and 3) compare the moral reasoning of physical therapists with that of other professional groups.
The Defining Issues Test of James Rest was used to evaluate moral reasoning. Five hundred thirty-seven physical therapists responded to a mail survey sent to a random sample of 2,000 American Physical Therapy Association members. Twelve physical therapists with expertise in ethics or professionalism completed the same survey.
The mean postconventional score for the random sample was 41.93. This score was lower than the mean scores of physicians, nurses, medical students, nursing students and dental students established in previous research. Females, ethics experts and those in academic settings had higher postconventional scores.
Physical therapists scored lower in postconventional moral reasoning than some other professional groups with similar educational background. Factors that may inhibit or enhance the development of moral reasoning among physical therapists and possible consequences of high or low moral reasoning scores in physical therapy require further research. These findings may raise concerns about the entry-level educational curriculum and professional development opportunities in the area of ethics and moral reasoning. Results of this research may also highlight the challenges of evaluation, scholarship and research in physical therapy ethics. Further research and theory development is needed to address the relationships between moral theory and descriptive or empirical research within physical therapy.
In June 2009, the House of Delegates (HOD) of the American Physical Therapy Association (APTA) passed a major revision of the APTA Code of Ethics for physical therapists and the Standards of Ethical Conduct for the Physical Therapist Assistant. The revised documents will be effective July 1, 2010.
The purposes of this article are: (1) to provide a historical, professional, and theoretical context for this important revision; (2) to describe the 4-year revision process; (3) to examine major features of the documents; and (4) to discuss the significance of the revisions from the perspective of the maturation of physical therapy as a doctoring profession. PROCESS OF REVISION: The process for revision is delineated within the context of history and the Bylaws of APTA. FORMAT, STRUCTURE, AND CONTENT OF REVISED CORE ETHICS DOCUMENTS: The revised documents represent a significant change in format, level of detail, and scope of application. Previous APTA Codes of Ethics and Standards of Ethical Conduct for the Physical Therapist Assistant have delineated very broad general principles, with specific obligations spelled out in the Ethics and Judicial Committee's Guide for Professional Conduct and Guide for Conduct of the Physical Therapist Assistant. In contrast to the current documents, the revised documents address all 5 roles of the physical therapist, delineate ethical obligations in organizational and business contexts, and align with the tenets of Vision 2020.
The significance of this revision is discussed within historical parameters, the implications for physical therapists and physical therapist assistants, the maturation of the profession, societal accountability and moral community, potential regulatory implications, and the inclusive and deliberative process of moral dialogue by which changes were developed, revised, and approved.
Do we have free will, or are all of our choices predetermined?
This survey was an attempt to identify which ethical decisions are most frequently encountered and are most difficult to make for practicing physical therapists. A questionnaire that described 30 situations with an ethical dimension was sent to 450 American Physical Therapy Association members practicing in New England. A total of 187 (41.5%) usable questionnaires was returned. Issues raised by items were designated as primary, secondary, or nonpriority. Seven primary and 11 secondary ethical issues were identified. In brief, these issues involve the decision about which patients should be treated, what obligations are entailed by that decision, who should pay for treatment, and what duties derive from the physical therapist's relationship; with other health professionals, including physicians. Some of these decisions are more frequent in certain types of employment facilities than in others. Sources of ethical conflict and the role of the professional organization in defining moral values for the profession are discussed in this paper, and implications for education are presented.
The author challenges the recently argued position of Helga Kuhse that caring is merely a preparatory stage to moral action and that impartial, principled thinking is required to make action moral, by suggesting a notion of caring as virtue. If caring is a virtue then acting from that virtue will be acting well. Acting from the virtue of caring involves eight features, which include not only that of being sensitive to, and concerned about, the patient, but also that of being aware of, and sensitive to, the relevant ethical principles. In this way, caring is seen as an overarching quality that gives action its moral character. The moral character of an action does not derive only from its having been performed in the light of principles.
Humans are endowed with a natural sense of fairness that permeates social perceptions and interactions. This moral stance is so ubiquitous that we may not notice it as a fundamental component of daily decision making and in the workings of many legal, political, and social systems. Emotion plays a pivotal role in moral experience by assigning human values to events, objects, and actions. Although the brain correlates of basic emotions have been explored, the neural organization of "moral emotions" in the human brain remains poorly understood. Using functional magnetic resonance imaging and a passive visual task, we show that both basic and moral emotions activate the amygdala, thalamus, and upper midbrain. The orbital and medial prefrontal cortex and the superior temporal sulcus are also recruited by viewing scenes evocative of moral emotions. Our results indicate that the orbital and medial sectors of the prefrontal cortex and the superior temporal sulcus region, which are critical regions for social behavior and perception, play a central role in moral appraisals. We suggest that the automatic tagging of ordinary social events with moral values may be an important mechanism for implicit social behaviors in humans.
Ethical dilemmas are inherently challenging. By definition, clinicians decide between conflicting principles of welfare and naturally confront competing pulls and inclinations. This investigation of students' responses to an ethical scenario highlights how emotions and concerns can interfere with willingness to implement ethical knowledge. Clear-cut rules are the exception in psychotherapy, and clinicians must judge ethical issues on the basis of the unique context of each case. As such, subjectivity and emotional involvement are essential tools for determining ethical action, but they must be integrated with rational analysis. Strategies for attending to influential emotions and contextual factors in order to mobilize ethical commitment are described.
Beginning with an exemplary case study, this paper diagnoses and analyses some important strategies of evasion and factors of hindrance that are met in the teaching of medical ethics to undergraduate medical students. Some of these inhibitions are inherent to ethical theories; others are connected with the nature of medicine or cultural trends. It is argued that in order to avoid an attitude of evasion in medical ethics teaching, a philosophical theory of emotions is needed that is able to clarify on a conceptual level the ethical importance of emotions. An approach is proposed with the help of the emotion theory Martha Nussbaum works out in her book Upheavals of thought. The paper ends with some practical recommendations.
The literature surrounding the teaching of ethics in physical therapy lags behind that in nursing and medicine. Yet, in everyday practice, physical therapists are required to make decisions based on ethical reasoning in such areas as telling the truth to patients, gaining informed consent, prioritization, and rationing of care. Decisions based on ethical reasoning are often challenging to clinicians, raising the question, "How can the necessary decision-making skills be acquired?" This article considers the rationale and delivery of an undergraduate ethics program at the University of Southampton in England. The course has been designed to facilitate ethical reasoning with student physical therapists and occupational therapists throughout their training. To illustrate the use of decision-making skills, two sessions from this ethics program are described (on resources and informed consent). The article concludes with a reflection on the experience of teaching strategies to facilitate ethical reasoning.
Abstract Many of the activities of clinical practice happen to, with or upon vulnerable human beings. For this reason numerous nursing authors draw attention to or claim a significant moral domain in clinical practice. A number of nursing authors also discuss the emotional involvement and/or emotional labour which is often experienced in clinical practice. In this article I explore the importance of emotion for moral perception and moral agency. I suggest that an aspect of being a good nurse is having an emotional sensitivity to other human beings (patients), because this emotional sensitivity allows the nurse to perceive more accurately the context and perspective of the patient. It is thus important to the moral agency of the nurse and to morally sensitive clinical practice. As such education of the emotions should be a feature of the moral education of the nurse. A useful conception of the role of educated emotion in the moral life can be discovered in Aristotelian ethics.
The patient-therapist relationship in occupational therapy has been a blend of competence and caring with the emphasis fluctuating over the years between these two features. When patients tell stories about their experiences, they reveal widely differing views of occupational therapists, partly because of the different ways therapists manifest competence and caring during patient-therapist interactions. Images from stories suggest that some therapists unwittingly disappoint their patients. This paper examines the patient-therapist relationship as envisioned by therapists and patients to help occupational therapists recommit to the patient as a vital partner in a collaborative relationship.
The purpose of this study was to identify the current ethical issues facing physical therapists and (2) ethical issues that may be faced in the future by physical therapists.
The Delphi technique was used as the research design for this study. The panel of experts for the study were selected from Papers submitted by past and present members of the Judicial Committee of the American Physical Therapy Association. A series of three questionnaires were sent to the members of the panel. Following the Delphi technique, the first questionnaire contained broad questions designed to elicit a wide range of responses. The second and third questionnaires were then developed from the information received in the preceding questionnaire.
The results of the first question of the study identified 10 current ethical issues as consensus choices by the panel and 3 issues as near-consensus. The panel responses to the second question identified 4 future ethical issues. A combined list of current and future contained 16 issues in physical therapy.
The 16 issues addressed ethical considerations in different areas of physical therapy practice: 6 issues involving patient rights and welfare, 5 professional issues, and 5 issues relating to business and economic factors. Thirteen of these issues have not been discussed in previous physical therapy literature and would be suggested topics for future study.
To identify ethical dilemmas experienced by occupational and physical therapists working in the UK National Health Service (NHS). To compare ethical contexts, themes and principles across the two groups.
A structured questionnaire was circulated to the managers of occupational and physical therapy services in England and Wales.
The questionnaires were given to 238 occupational and 249 physical therapists who conformed to set criteria.
Ethical dilemmas experienced during the previous six months were reported by 118 occupational and 107 physical therapists. The two groups were similar in age, grade, and years of experience. Fifty of the occupational therapy dilemmas occurred in mental health settings but no equivalent setting emerged for physical therapy. Different ethical themes emerged between the two groups, with the most common in occupational therapy being difficult/dangerous behaviour in patients and unprofessional staff behaviour, and for physical therapists resource limitations and treatment effectiveness. No differences were found in the ethical principles used.
The ethical dilemmas reported by the therapists were primarily concerned with health care ethics, rather than the more dramatic ethics reported in much of the biomedical ethics literature. Differences were found between the two professional groups when ethical contexts and themes were compared but not when ethical principles were compared. This suggests that educators and researchers need to be aware of work settings and the interdisciplinary nature of employment as well as ethical principles held by individual therapists.
Applying standards of virtue that define the "good doctor" in a complex and technologically sophisticated health care system is often challenging and sometimes confusing. What are the characteristics of a "good doctor," who wishes to live up to high ethical and professional standards but who also must live and work in a health care system in which moral ambiguity is pervasive? Medical educators are urgently faced with such questions as their schools try to equip students with the skills and capacities required of the virtuous physician. The author describes how Aristotelian concepts of virtue can be used to guide medical educators in defining and teaching virtue. He then discusses how such traits as the ability to tolerate moral differences and ambiguity, the ability to develop thoughtful individual moral positions, and the capacity to respect and understand various cultural traditions may be what might be considered virtues in today's health care system. A "good" doctor, then, would be someone who is thoughtful, fair-minded, respectful of differences, and committed to his or her professional values.
Emotional reactivity in infancy and early childhood may play a role in the regulation of brain plasticity and hemispheric organization, which has possible implications for vulnerability to psychopathology. Empiric findings demonstrate the role of attachment patterns in emotional reactivity modulation and limbic circuitry shaping.