The role of clinical ethics consultations for physical therapy practice

Background and purpose: As autonomous practitioners, and as part of multidisciplinary health teams, physical therapists encounter unique and complex ethical challenges. Frameworks and models of ethical decision-making have been developed to assist therapists to integrate ethical theory and principles with the needs, experiences, and opportunities of their patients and patient communities. However, there is little in the way of clinically based courses and practical approaches to assist physical therapists to recognize and respond to the ethical issues that they encounter in their everyday practice. Objectives: This paper proposes clinical ethics consultations as a practical mechanism to assist physical therapists to identify and negotiate the ethical dimensions of their everyday practice. Clinical ethics consultations aim to resolve conflict, facilitate communication, and ease moral distress in health care. The strategies used are to identify common ground between differing values expressed, use questions to examine harms and benefits of clinical actions, and model approaches for thinking about and framing ethical challenges and facilitating participants to see their own positions relative to others. Three narratives highlighting ethical issues in physical therapy clinical practice are used to demonstrate how a clinical ethics consultation might provide a structured exploration of ethical issues. Conclusions: To develop capacity for moral action in everyday practice, therapists need skills in clarifying their ethical values and professional moral obligations and ultimately, to make decisions which are in the best interests of their patients. Clinical ethics consultations are one way to advance this area of professional practice.