Physical therapy and a public health ethics perspective

Physical therapists have recently broadened their professional activity into the sphere of community and public health. Work on the ethics of physical therapy, however, has focussed largely on issues that arise within the traditional therapist-patient dyad. This paper explores the place of a public health ethics perspective within physical therapy, and considers the way in which the values and principles that have customarily informed ethical debate in physical therapy may need to be reconsidered and applied in different ways. Initially, the nature of public health, and by extension of public health ethics, is considered, and a distinction between 'narrow' and 'broad' definitions of public health is drawn. The current and potential role of physical therapy in public health is briefly discussed, and three specific areas are then explored: priority setting, autonomy in relation to health promotion, and involvement in the political sphere. It is argued that engagement with issues such as these requires a different approach to ethical decision making, and also a reappraisal of the boundaries of the professional role.