Ethical dilemmas in occupational therapy and physical therapy: a survey of practitioners in the UK National Health Service

Objectives-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. Design-A structured questionnaire was circulated to the managers of occupational and physical therapy services in England and Wales. Subjects-The questionnaires were given to 238 occupational and 249 physical therapists who conformed to set criteria. Results-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. Conclusion-The ethical dilemmas reported by the therapists were primarily concerned with health care ethics,(1) rather than the more dramatic ethics reported in much of the biomedical ethics literature.(2) 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.