7

Ethical

decisionmaking in
physiotherapy
Julius Sim

INTRODUCTION
This chapter is to do with the place o f health care ethics within physiotherapy.
It is, therefore, appropriate to start b y trying to outline what is to be understood b y 'health care ethics'. For the purposes o f this chapter, I take this to
mean the application of ethical reasoning to the context of health care, so as
to identify those courses of action which are morally right, and therefore to be
followed, and those which are morally wrong, and therefore to be shunned.
Thus we are dealing with a decision-making procedure, but one which is
primarily guided b y moral criteria, as opposed to clinical, administrative, or
other considerations.
A number of important points follow from this initial statement. First,
ethical reasoning is applied to health care, it does not spring from within it.
Consequently, there is no such thing as 'physiotherapy ethics', or for that
matter 'medical ethics' or 'nursing ethics'. T h e particular situations with which
we are dealing may 'belong' to physiotherapy, but the ethical principles that
are applied to them are universal. It follows that health care practitioners can
claim no specific moral authority on the basis of their professional expertise.
T o be sure, such expertise will often b e relevant when dealing with moral
dilemmas, but it does not itself confer any special authority in ethical matters.
Second, the ultimate end of the process is to take action. W e are not engaged
in abstract contemplation or idle philosophical speculation; ethical reasoning
in health care is an action-oriented business. Third, we are concerned with
what is morally right. T h e fact that a certain course of action may be correct in
terms of clinical judgement does not per se guarantee that it is the right thing
to do morally. W h a t may seem an appropriate decision on clinical grounds
may be morally objectionable, and, conversely, what may seem a dubious
decision in terms o f clinical judgement, may have much to recommend it as a
moral course of action. This further reinforces the point that professional
expertise does not carry with it moral expertise. It is also worth noting that, as
we will see, the processes o f ethical and clinical decision-making may be quite
similar, even though they sometimes yield very different conclusions. Finally,
it should be stressed that we are dealing with matters o f ethics, not etiquette
(Sim, 1 9 8 3 ) . Professional courtesies are important, but they do not necessarily
raise ethical issues. T h e notion of 'professional ethics' has c o m e to embrace
86