Author Archives: Chantelle van den Berg

About Chantelle van den Berg

-Paediatric Physiotherapist (private practice owner) -Special interests: breastfeeding & lactation, respiratory therapy, neuromotor development and orthopaedic rehabilitation. -South African Society of Physiotherapy's Paediatric Group Committee (Western Cape Branch manager)

Week 6: Overview & Reflection


The Physiopedia  PHT402 Professional Ethics Course has been such an exciting CPD activity and eye-opening experience.   It is  a blessing to be able to connect with physiotherapists and students from different walks of life, all around the globe, as each on of us have valuable and diverse perceptions and opinions to share.  It has been an amazing journey, brainstorming, writing and discussing challenging and thought-provoking moral and ethical dilemmas of life and physiotherapy practice.  This will be my final blog post reflecting on the PHT402 course and my learning portfolio.


albert einstein


The themes I found particularly difficult was equality, torture and assisted dying.  These topics challenged me to objectively look both sides of the coin and argue the point of view or opinion I share.  I tried to look at it, firstly as a human being and secondly as a health care professional.  After receiving some feedback from my peers, I realised that I kept my distance from sharing too much of my professional experience in every post, as I felt that I may become judgmental if I try and use patient experiences and analyse their behaviour or decisions.  In addition to my weekly post, I wrote a reflective post after reading and discussing with other participants the theme of the week on my original blog post and theirs, which made it easier to identify areas I need to develop and summarise opinions and perspectives.  As in life, there were some participants who did not share my opinion on or perception of various topics/themes, but I respect this difference of opinion and accept that it is their prerogative to freedom of speech and expression.  Furthermore, I applaud the brave participants who went against the grain and who took an honest  look at themselves and/or their lives and admitted their fears, shortcomings, challenges and personal experiences.  It is a wonderful opportunity to be “forced” to be open-minded and take a good, hard look at yourself, your life and your practice.  I will definitely incorporate what I have learned in my life and practice.  Mostly to be careful of becoming too involved with my little patients and truly respect the decisions and opinions of all my patients, while still following the rule of the law.


It was really hard for me to write my blog post on equality, as I had so much to say and found myself jumping around and not settling on a specific direction.  Growing up and living in South Africa, I had to be sensitive and really search high and low to find diverse and relatable information on equality.  It was so interesting to read the posts by my fellow participants residing in a different country, experiencing equality, as a global issue and struggle.  To sum up my opinion on equality…  Equality is an idealistic notion.  Due to political and social interference, inequality is more common in reality.   You have no right to judge or discriminate against another human being because you don’t approve of their choices or behaviour.   It is with sensitivity and an open mind that we need to approach matters of equality, as seen in the current debate on marriage equalityracismsexual orientation and gender identity.   I believe that focusing on how you act and engage with others, is what is important. It is a personal goal to try and see people without judgement, as your equal, a human being, deserving of equal respect, protection, understanding, kindness and care. This should be carried forward into our practice as health care professionals.


Week 4’s theme of torture really touched me deeply.  Just imagining being tortured or someone I loved being tortured gave me such an emotional reaction that it took me some time to gather my thoughts and start researching this topic objectively.  The discussion on my blog post and many other participants’ blogs, revolved around when we condemn torture for one reason but perceive it as acceptable for another.  I am still of the opinion that the concern needs to be on the protection of the human rights of all human beings.   I believe we should respect the rule of law and the principle of upholding fundamental rights and freedoms, for all, even when we personally feel that a person (terrorist or criminal) is not deserving of any rights as a human being.  This is particularly important in clinical practice where student-physiotherapists and physiotherapists in public health sector are faced with treating incarcerated human beings.  As health care professionals we must treat all our patients equally without judgement and not allow or cause them any discomfort or pain as a result of refusing or delaying treatment (as seen in the Steve Biko case).   It is sad that torture is still in practice, globally, behind closed doors in police and military custody.


This 5th week’s theme of assisted-dying and end-of-life decision-making, was difficult for me as a physiotherapist (who is trained to improve quality of life) and a Buddhist (who believes in freedom from suffering), trying to objectively see and argue both sides of the coin without judgement. I have no idea what my choice will be when I am in a situation where I am given the choice or when it comes up in a discussion again. That is the beauty of life, we grow, we change, we evolve.   I know that my opinion and perspective on this will change as my life changes in the years to come.  Exploring the relationship and comparison between passive involuntary assisted-dying (legalised abortion) and voluntary assisted-dying (the last human right) helped me put things in perspective.  After reading my fellow participants’ blogs, I conclude that everyone has the right to life and to be treated with dignity and respect, in life and death.


I would like to thank all my fellow participants for reading my posts and engaging discussions on these sensitive topics that we face on a daily basis in life and practice.  I will leave this course as a better human being with a new found understanding and goal, to live a balanced life, cherish human compassion and seek further understanding of the complexity of human connection.


I will leave you with “The Physics of the Quest”, something to live by:

“If you are brave enough to leave behind everything familiar and comforting;

and set out on a truth-seeking journey;

and if you are truly willing to regard everything that happens to you on that journey as a clue;

and if you accept everyone you meet along the way as a teacher;

and if you are prepared, most of all, to face and forgive some very difficult realities about yourself;

Then truth will not be withheld from you.”

Elizabeth Gilbert: Eat, Pray, Love


For PHT402 Professional Ethics Course: Week 6: Overview


Week 5: Reflection


This week’s reflection will be short and sweet as I spent alot of time on my original blog post arguing both sides. I will therefore reflect of what I’ve learned and concluded from my fellow participants’ blog posts on this sensitive and controversial subject of assisted-dying.


I really identified with other participants, who felt uncomfortable and unsure about their opinions on assisted-dying.  I had to challenge my own opinions and really try and see both sides of the argument for/against assisted-dying.  Wendy said that “we should just to stick to the clear moral path that Killing is Wrong and we should always strive to save lives and to enhance the quality of life”.  On the other hand, Jackie concluded that “because we will never truly understand and empathize with somebody who legitimately requests for assisted suicide, the bottom line is that assisted suicide is “necessary” and it should be allowed for severe and extreme cases but it must never be abused by patient or physician”. I don’t think that there will ever be a consensus on this topic, just as abortion has been legalised, although the majority believes this still to be wrong.  I completely agreed with Kim’s opinion that we should respect and support the decisions of our patients without judgement.


What I have realised in life, is that when you are in a certain phase of your life, it is impossible to imagine how you would react or feel about a certain topic at another time in your life, when you are experiencing something you’ve never experienced and are faced with difficult decisions you’ve never had to consider.  As I discussed in my original Week 5 blog post, I cannot make hard and fast decisions and form opinions about something I have never faced as currently my life has a different meaning than what it would if I have children, or if I have a terminal illness.  I also cannot judge another human being for wanting to end his/her suffering.  Who are we to judge?  As discussed in my original blog post, the story of the South African Professor who assisted his mother to end her life and fulfill her last human right, made me think that, given the situation and how it impacts your life, I would do that for my mother.  Seeing someone suffer and in constant physical or emotional pain, breaks your heart.  I agree with Jarryd comparing human assisted-dying with euthanasia of our pets.  We as humans choose to end the life by euthanasia of a beloved pet who is suffering when medical intervention will not be effective in curing or reducing the pain and disability.   But as human beings, with all the Human Rights, we have no say about when and how we choose to die and that we should just suffer and keep fighting.  Sometimes it’s braver to let go and be at peace with your life and to say that you have had enough.  I will only know when I get there.  Lisa also mentioned that perhaps assisted-dying can be understood and regulated under the law without having such dire consequences.


Theo made a very valid point:  “What is worse… Letting that person suffer or offer to end their suffering so they can have peace?”. She continues saying that as health care professionals, many believe that we should promote and value human life…  Cecil also touched on this but took it further by saying that our ability to make our own choices and take responsibility for our decisions is part of the human gift of autonomy and we should exercise this right in life, and death.


I still believe, “my life, my choice” and everyone deserves a dignified death.



For PHT402 Professional Ethics Course: Week 5 – Reflection


Week 5: Assisted-Dying


“A belief in assisted-dying is by no means a fringe view in western society.
There is broad agreement, associated with notions of modernity and evolved thinking,
that assisted-dying is an appropriate action to take in certain cases and should be allowed by law”
Bruce Falconer


Discussing this concept of assisted-dying, which is a choice at the end of the day, with anyone can be difficult and challenging, not just because of differences in religious/spiritual beliefs, moral values, legislation and medical-ethical considerations, but for the multiplicity of terms used to describe it.  Terms I think are relevant to this discussion are active and passive, voluntary and involuntary assisted-dying and physician-assisted-dying. Many other terms such as suicide and euthanasia (active/passive, voluntary/involuntary, by omission/action) and are also used but carries social stigma and negative religious connotations.

This week’s theme of assisted-dying and end-of-life decision-making, has been difficult for me as a physiotherapist and a Buddhist, trying to see both sides of the coin… The individual right to life and to be treated with dignity and respect versus the bigger picture of the society and the impact of such legislation.  Buddhists are not unanimous in their view of physician-assisted dying, and the teachings of the Buddhadharma don’t explicitly deal with it. In Buddhism, the way life ends has a profound impact on the way the new life will begin. So a person’s state of mind at the time of death is important – their thoughts should be selfless and enlightened, free of anger, hate or fear. This suggests that suicide, albeit assisted or not, is only “approved” for people who have achieved enlightenment and are at peace with themselves and the life they had.

Personally I do not believe in artificial means of prolonging life.  I believe in the “do not resuscitate” order, also known as the “No Code”, which may be seen as a passive assisted-dying by some.  Dying does not scare me as it’s part of life, the natural progression of life, or if your life is cut short, it’s part of the path you had to or need to walk. Perhaps my perspective will change once I have children.  Then the thought of leaving them behind will make me reconsider.  But at this stage in my life, I believe that your time is your time and letting nature takes it’s course after you’ve exhausted all your options in medicinal and therapeutic terms.  But science has made it possible to cure disease, recover from disability, reduce perceived pain and suffering and improve quality of life, so I do believe that you should make use of what is available.  Therefore I am not pro assisted-dying for myself, but I am not against it for others.

The potential negative consequences or effects after resuscitation and prolonging life artificially is a reality, so too are the life saving chances. I have seen this with some of the kids I have treated.  One is a little boy who was brain dead after a car accident and his parents instructed the doctors to save him and keep him on life support as long as possible.  They had to resuscitate him 3 times and after 5 months of living on machines, he only recovered enough to sustain breathing through a trachi (tracheotomy), with a “Glasgow Coma Scale” of 3 (Eye 1 (no reaction or movement), Verbal 1 (no expression, sound, attempt), Motor 2 (reacts to painful stimuli)), which hasn’t improved or deteriorated in the last 2 years.  But he needs 24h care, therapy and constant medical attention and intervention.  Is this a life worth having or living, or is it selfishness to have forced life despite the package it comes in?

Then there’s the question of physician-assisted-dying.  This really hit home in 2012, when Sean Davison, a physician, professor and head of the Forensic DNA Analysis Lab at The University of Western Cape in South African, returned home after five months’ house arrest in New Zealand for helping his terminally ill mother die.  He was found guilty of the lesser charge of counselling and procuring the suicide of his mother, by giving her, as requested and consented, a lethal dose of morphine after she tried to starve herself to death.  He has formed a non-profit organisation, Dignity SA and hopes to educate people and champion a law change in South Africa.

I agree with the slogan of Dignitas, “To live with dignity, to die with dignity” and that this is the last human right, or it should be.  But unfortunately the mastermind behind the Dignitas organisation (an international centre for assisted-dying), Ludwig Minelli (a self-described humanitarian and lawyer), who might have had the best intentions to start with, has become something of a side show and with his toxic reputation, has resorted to shocking the public and forcing his opinions on others.   Under Switzerland’s permissive and unique legal environment,  assisted-dying has developed into suicide-tourism.

The problem we have is that every human being has the right to life and a quality life at that, but quality is subjective and each person has their own perspective on what living a quality, full life means.  Two people with terminal cancer will not consider assisted-dying the same, they will not consider medical management and intervention the same… but is their suffering the same, as pain, stress, discomfort and fear are all perceived emotions, reactions and sensory processing which varies from person to person?  So why does one person choose to fight to the end, whilst another lets nature takes it course?  And what about people who are choosing to “give up” or end the suffering and requires assistance?  Should they have the choice?  Tony Nicklinson who suffers from Locked-in Syndrome has been fighting against the legal system for “Death with Dignity” laws.  These laws allow a terminally ill patient to hasten an inevitable, insufferable and unavoidable death. It’s not suicide or euthanasia; rather, a possible option if the physical or emotional  pain from the underlying illness gets to be too much or quality of life too degraded. If one is of the opinion to agree with legal active and passive assisted-dying for compos mentis, suffering, living, human beings, what would be the criteria? Should this be a right to all suffering human beings, a choice of how they want to live and die? But what about a person who has lost the will to live?  Should they have this right or is this only for people who have exhausted all medical or health/healing interventions and therapies in trying to recover, reduce or manage the pain and disability?  And then, is emotional and physical pain the same?  Are we to say that such people are weak? Are we to say that everyone should endure?

If we think about it, compared to abortion, it makes the moral question a bit more simple.  In South African it is legal to have an abortion, even from the age of 13, as shocking as it may be for some.  Medically speaking in terms of anatomy and physiology, the embryo as a blastocyst has living cells after implantation on day 8-10 and then the embryo develops into a fetus at 8 weeks gestation when heart cells start beating.  Furthermore, from 10-13 weeks gestation, the fetus’s nervous system sensitizes and develops integration of pain/noxious stimuli which cannot be termed a mere reflex. The fetus also bears all human traits at this stage including the basic/core structure of cardiac-circulatory and nervous system cells, which are reactive.  But abortion is legal up to and including at 13 weeks gestation.  Thus it can be seen as involuntary assisted-dying of the unborn fetus (although the mom is the active participant and decision maker).  Others might call this murder.  Just because the baby is inside the womb, once it has a heart beat, it is considered alive, a living human being. So what makes a born living human being’s life more important or special than a unborn human being’s life?  Thus scientifically speaking within morality and ethics, the answer to involuntary and passive assisted dying is quite straight forward, it’s wrong.  I believe that voluntary assisted-dying is a choice as you alone are responsible for your own life, and the choices you make.

A great video on the assisted-dying debate:


For PHT402 Professional Ethics Course: Week 5 – Assisted-Dying

Week 4: Reflection


“The healthy man does not torture others – generally it is the tortured who turn into torturers”
Carl Jung


I completely agreed with Emma, Amie and Tamaryn’s  posts on Torture, concluding that torture in an unacceptable practice and in violation of Human Rights.


Tony discussed the implications and use of torture by physiotherapists, a side of this topic that I didn’t even think of  when I wrote my original post.  What about when a physiotherapist is causing unintentional pain and discomfort to an uncooprative bedridden patient with Alzheimers and Dementia with contractures and bedsores.  Let’s say this patient is not “compos mentis” and their family (right of attorney and legal guardian) have agreed to therapy as prescribed by her physician.  Now this patient is refusing any touch or movement…. If you stretch or mobilise her and it hurts, or she communicates that are you causing her pain just by touching her skin and she is refusing to do any movements or exercises, is this torture?  If you move her and she screams, and you continue with the stretches, although you know this pain perception is abnormal due to her cognitive state, are you torturing this patient?  This really made me think as most physiotherapists have been in this position.  I don’t believe that this is torture as we are not deliberately trying to cause pain to obtain something from her or to teach her a lesson or just because we are sadistic and want her to suffer.  We are trying to help her as a health care professional with the medical knowledge to know what physical and emotional reactions are appropriate or normal in terms of anatomical and physiological functioning.  As physiotherapists we know that the discomfort felt from stiffness with light stretches or mobilising exercises or supported positional changes (without forcing into end range etc), is more “soreness”, not painful as perceived.  Especially if this patient reacts with abnormal perceived pain with any touch (such as being washed, dressed, hair combed, teeth brushed etc). We are not doing any harm, but improving functional ability and preventing further damage or secondary complications through our treatment. Thus I believe in this instance we are not torturing the patient. This patient might view being washed by the nursing staff as torture, but those sound of mind know what is being done is esssential care and not harmful.  If a “compos mentis” patient refuses your treatment and you go against their will and force treatment on them, or hurt them on purpose by forcing stretches beyond subjective comfort or refusing to help them when they are in pain or discomfort, that is another story.   Marna also discussed this area of potential torture in patient care in her blog post.


Torture can also be seen as intentionally delaying essential care or providing minimal or refusing assistance or intervention causing a patient to remain in pain and suffer.  This is also against to Hippocratic oath and the HPCSA National Health Act and Health Professions Act, to do no harm.  This is what happened in the Steve Biko case I discussed in my original post.  Kim also discussed this and I found the words from one of the offending medical practitioners in this case, very central to this topic of allowing or assisting with torture due to the political or social context;  “a medical practitioner’s first responsibility is the well-being of his patient, and that a medical practitioner cannot subordinate his patient’s interest to extraneous considerations.” Tucker 1991


Still, torture is being used behind closed doors by police and military forces.
This is a 2013 video of the torture and violence inflicted on innocent human beings in South Africa:


What about the saying “an eye for an eye” or that a criminal such as a murderer or child rapist deserves to be violated or tortured and stripped of his Human Rights?  Well, in recent weeks, Carte Blanche ran a story of men that were accused of being child rapists only to be released after 3 months in prison where they were subjected to violence and were told that they “deserve to be tortured, violated in prison and suffer a painful death” by many in the community.  As there were no circumstantial evidence and forensics linking them to this, they were released and the actual guilty child rapist was identified by DNA analysis and charged. Do you even know how many innocent people go to prison for crimes they didn’t commit? This happened with another man who was “framed” by the police for allegedly killing his girlfriend, but only after spending time in prison and going through the process of appeal did the legal system prevail and found that evidence was fabricated and that he could not be linked to this murder. The court also found that the police maliciously pursued this young man and knowing that he was innocent, they tried to ruin his life.  So taking Human Rights away from prisoners or saying that they deserve to be violated or tortured, can never be the right answer.


I will end off with the words by Ghandi as quoted by Jackie and Jamie-Lee:

“An eye for an eye makes the whole world blind”



For PHT402 Professional Ethics Course – Week 4: Torture


Week 4: Torture & Human Rights


“The argument cannot be that we should not torture because it does not work.
The argument must be that we should not torture because it is wrong.”
Jason Michelich 

human rights

Next month will mark the 36th anniversary of the death and case resolution of anti-apartheid activist Steve Biko, who in 1977 died of head injuries sustained during interrogation/torture while in South African Security Police custody, with identified gross inadequacies in the medical management.  In addition, since 2008, Xenophobia hit South Africa like a disease, and it’s still relevant.  Many black South Africans living in the townships felt that the massive, uncontrolled influx of “illegal immigrants” or “asylum seekers” were taking the job opportunities from the “native black South Africans”, which has led to acts of Xenophobia (including discrimination, violence and torture) in a community already suffering from social crises and poverty.  The concern needs to be on the protection of the human rights of all human beings, including foreign nationals.  Another relevant issue of  torture and human rights violation occurred in the South African “Marikana” massacre in 2012, with 44 deaths and 76 injured South Africans.  Police brutality (lethal use of force) reared its ugly head again, but this time it was not the white Apartheid Police Force firing upon black South Africans, it was the “new South African” Police Force, firing on their own people, supposedly in self-defense and crowd control.  The South African president commissioned an inquiry to investigate matters of public, national and international concern arising out of the tragic incidents at the Lonmin Mine in Marikana.  Should the police have acted so brutally and opened fire on all the strikers or just those that were attacking them, those that “initiated” the attack?  What about those human beings, the “strikers”, who were shot in the back as they were running away and those that were “gunned down” and even tortured before death?

These events have led to Amnesty International publishing a document in 2012 on the current status of and recommendations to the South African Prevention and Combating of Torture of Persons Bill, urging that its scope be expanded to reflect the full extent of South Africa’s obligations under the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment and to uphold and protect the rights of asylum seekers and refugees.  As we have discussed in week 3 on the topic of equality, violating, suppressing basic human rights of any human being, is legally, morally and ethically wrong.

There has also been much talk and controversy surrounding the 2013 released blockbuster “Zero Dark Thirty” as it depicts the use of military and intelligence interrogation and torture-practices in the “fight against terror”.  Torture, carried out or sanctioned by individuals, groups and states throughout history from ancient times to modern day, is the act of deliberately inflicting intense physical pain, combined with emotional/psychological stress and deprivation of basic care and needs, to a person who is unable to protect himself.  The reasons for torture include interrogation, punishment, revenge, political or the sadistic gratification.  Many support the anti-torture argument on the fact that torture is hugely unreliable means of obtaining information, that often turns out to be redundant or misleading.  Others argue that the “well-being and protection of defenseless human beings and for the greater good of the country” it is more important than the issue of violating Human Rights of  a terrorist or criminal/prisoner of war.  Pro-torture individuals or groups often state that “brutalization brings breakthroughs”, and that torture is at times necessary or required to gain valuable intelligence/insight/information to stop future attacks/violence and to bring criminals/terrorists to justice.  For me, more importantly, and from a Human Rights point of view, torture is morally and ethically wrong.

We all know that terrorist activity violates various Human Rights, including the right to life; rights to non-discrimination, including equal rights for women and girls; right to a fair trial; freedom of religion and belief; freedom of expression and information; the right to vote and participate in public affairs etc.  Therefore, measures against terrorism can have an important role in protecting human rights but counter-terrorism laws can also have a profound impact in limiting fundamental human rights and freedoms, including the right to a fair trial; the right not to be subjected to arbitrary detention; freedom from torture and cruel, inhuman or degrading treatment or punishment; the right to freedom of expression; the right to freedom of movement; the right to privacy; the right to non-discrimination and the right to an effective remedy for a breach of human rights.

So the question is, should a terrorist “loose” his rights as a human being?  What about a criminal who took the life of an innocent human being or child?  Should he/she still have rights?  I believe we should respect the rule of law and the principle of upholding fundamental rights and freedoms, for all, even when we personally feel that a person (terrorist or criminal) is not deserving of any rights as a human being.


For PHT402 Professional Ethics Course:  Week 4 – Torture & Human Rights

Week 3: Equality


It has been said that equality is central to basic human rights that every human being in the world should be entitled to. But lets be honest, are we all equal, or are some more equal than others?




The problem with equality in our modern world, is that often times the political or social climate (power & superiority) reduces the quality of life, freedom and growth of certain groups and in turn forces the enhancement and above-the-law protection of specific politically/socially suited “lesser” groups,  in order to attain this ideal of equality and protect against discrimination.  But  there cannot be true equality, real fairness without freedom. You cannot sacrifice the one for the other.  There will never be true equality under such a system.  Equality means that every human being should see and treat every other human being equally before the law regardless of their race, gender, sexual orientation, gender identity, national origin, ethnicity, religion or disability without privilege, discrimination or bias.  Yes, you need to protect and create opportunities for the ‘weaker or lesser’ groups of people, but not by sacrificing, impeding or discriminating against other groups or individuals.  This system also allows people the protection and right to make excuses for their behaviour by blaming external factors and ‘getting away with murder” as they are the politically favoured group.  Forcing equality can create massive divides and socio-economic break-down within a community and a nation.  Thoughts and feelings of hate, jealousy and frustration with power-hungry mindsets and egocentricity are driving forces for inequality. In our country South Africa, there is blatant discrimination and inequality happening in almost every sector, level and facet of our lives.  And the whip is in the hands of the politically and financially privileged and powerful.  


People fear what they don’t understand, and that leads to dangerous thoughts and behaviour.  People will also hide behind or grab onto what makes them feel comfortable and safe.  Is it then acceptable or understandable to be judgmental or opinionated on the behaviour or rights of others, because of your personal, religious or cultural beliefs? My answer is no. You have no right to judge or discriminate against another human being because you don’t approve of their choices or behaviour.   It is with sensitivity and an open mind that we need to approach matters of equality, as seen in the current debate on marriage equality, racism, sexual orientation and gender identity.  


With that being said, I believe that focussing on how you act and engage with others, is what is important. It is a personal goal to try and see people without judgement, as your equal, a human being, deserving of equal respect, protection, understanding, kindness and care.


Yes, we have freedom, but not equality:


For PHT402 Professional Ethics Course: Week 3 – Equality

Week 2: Reflection


After reading the various blog posts and comments from my fellow course participants, I felt the need to reflect and acknowledge the opinions expressed regarding this complex moral landscape and what influences it. I wanted to write and post my reflection earlier, but as it’s the month end, I’ve been a little preoccupied this week with patient accounts and administration of my practice.  So, albeit a little later than planned for this week, I would like to end the week’s topic of morality off by reflecting on and summarising my thoughts, before moving onto the next chapter, equality.

moral brain

During my research on this topic/theme, I found a very interesting link… Harvard University’s Cognitive Evolution Laboratory has an online Moral Sense Test. This forms part of a research project on “characterisation of the nature of our moral psychology, how it evolved, and how it develops in our species, creating individuals with moral responsibilities”. Reading the ethical and moral dilemmas given in this test/survey, made me realise even more how complex human behaviour, human connection and human cognition is…. Is there a “universal moral behaviour or code”?  Most of the questions dealt with sacrificing someone else’s comfort, health, freedom or life to save others, change a scenario or have a supposed-positive effect on the outcome.  It is also very interesting that in this test they ask you random questions about your personality, general opinions and likes/dislikes… all to profile your moral character.  Wendy and Charde also discussed the various contexts and experiences that influence our individual moral development.

To be a little philosophical, as a spiritual human being and a moral relativist, I argue against a single true morality…I believe to never do any harm or treat others unkindly.  I don’t believe that it is possible to have a universal moral code in this complex world we live in.  I believe in natural rights and moral relativism, as briefly discussed in my “Original blog post on Morality (Week 2)“. Natural rights are rights people have simply by virtue of being a human being, for example the right not to be harmed by others, and vice versa. I found an academic published paper on moral relativism by Gilbert Harman that really explains this theory well, including the typical criticisms from other cultural/religious moralists.  “The moral relativist supposes that different people accept different moralities which can give them different moral reasons.”  Religious dogmatism, personal experiences, freedom of choice/expression and cultural beliefs influence one’s moral character, exception and perception, as so eloquently described and referenced by Noam and Jackie.  I also found the article linked to Tony’s blog post, “Moral Courage in Health Care” such and inspiring and relevant read.  

I really appreciated the personal experiences shared by many physiotherapists and physiotherapy-students in their blog posts, referring to challenging clinical dilemmas with various ethical and moral questions.  Being compassionate and empathetic with a patient that is the cause of all her pain and disability, as Theo shared in his post, is difficult, but you must remember your place in this clinical setting.  Possibly in another setting, you might choose to act or interact differently with this person, again, then it all depends on your moral character and personality.  Ellen’s mind map summarised, in such a comprehensive and concise manner, what morality can be defined as, what influences it  (multi-factorial) and what impact it has on our lives and decision-making process.   To borrow from Carmin’s post, the quote by Laurence Sterne really sums it up:

“Respect for ourselves guides our morals; respect for others guides our manners”

Laurence Sterne


For PHT402 Online Professional Ethics Couse:  Week 2 (Morality)

Week 2: Morality


Morality exists within the limits of reason.
But is there a universal moral code, a right or wrong answer to any moral question?


Our experiences of the world and life are realised in the brain. Scientific research has found that the contributions of religion and society/culture affects neuroscience, therefore it affects how people, individually and in a group, view, process and act on context-specific information. Explicitly religious or societal/cultural beliefs and behaviors are at times in stark contrast with the “universal concept of morality”. Furthermore, religion and culture are often times the lens through which people view moral questions. Many view religion or societal/cultural beliefs/practices as a moral compass or guideline through the messy bits of life. Some may argue that a community, religious groups (often seen as dogmatism) or culture, needs to view itself as responsible for the moral growth of it’s members. But what about non-conformists, spiritual individuals or atheists…? Do they have no moral compass to guide them?  If two people are considered right from their cultural worldview and if moral variation exists, why not rather look at moral relativism instead of morality?

In health care, what my beliefs and opinions are with regards to my religious, spiritual, cultural or societal upbringing and experiences, has no place in the relationship with my patients nor, how I engage with them and what level and quality of care I provide. It comes down to universal human well-being, dignity and respect. If a parent of a patient of mine refuses to allow me to undress her child’s trunk to examine her spine, due to personal/religious or cultural beliefs, I need to respect that decision and value the difference of opinion. I need to educate and inform them of why that specific examination is crucial from a scientific/evidence-based point of view, but then explore and exhaust all other options to ensure they feel comfortable with their decision, that was not made under duress, within their religious or cultural context. Perhaps try radiography or palpation with marking of anatomical points… This has happened to me before in a clinical setting. Agree to disagree, and move on. This relates to our previous discussion on empathy with professional distance.

Yes, one can become frustrated with patients who have very idealistic and perhaps, from your perspective, limited or flawed views of the world and their health, but your job is to be neutral and see each patient as a human being. Your job is to provide excellent care and evidence-based health care education and support to all your patients within the universal code of morality guided by ethical laws, professional bodies and the legal framework of your country. An example is when a patient (of the Jehova’s Witness faith) refuses a blood transfusion, that could save his life. A compos-mentis person of legal age (age of consent or majority), as determined by law, can make his own informed decisions about his body and the way he chooses to live (including in health care). You cannot force treatment upon him, even if you are of the opinion, that what you are doing,  in terms of morality, is right, without exceptions. You are only relatively righteous in your opinion or behavior, as relative to your perverse contemporaries, not necessarily when observed out of context, or ”judged” by an absolute standard.

What about the Hippocratic Oath? Is this our moral high ground in health care? It requires a physician or health care provider to take an oath/pledge commitment, to uphold a number of professional ethical standards… So can this be seen as universal morality, a recognised standard of justice or goodness?

Other examples of moral questions are: A South African patient finds out that her child has an 80% chance of having Down Syndrome after going through the screening process as recommended by her Obstetrician/Gynaecologist (OB/GYN). With sensitivity and neutrality, she is educated about her options of termination/fetal abortion (legal in South Africa) or pregnancy progression and what the diagnosis entails regarding potential associated medical and functional problems, evidence-based medical and therapeutic interventions and quality of life. The OB/GYN cannot advocate termination because that is her opinion. Nor can she refuse to help the patient or inform her of termination because she is of opinion that she is making a terrible mistake. If the patient chooses to abort the fetus, is she a terrible human being who is killing a baby, a murderer? Or is she thinking about the well-being of her unborn, sparing the child of a life of disability, pain and suffering? Then, what if a woman was raped and carries the child of her rapist… Is abortion within the South African law, then OK? As a health care professional… My opinion on this doesn’t matter. And neither do yours. It is not your place to judge nor condemn the actions of others, as it is not your life and it does not affect you. That is the problem with morality, it is subjected to religious, personal and cultural beliefs/practices and if we believe in human connection, understanding and respect, we should practice what we preach. Leave all judgement at the door.

Ideally, we would want everyone to be guided by a universal moral code as some religious and societal/cultural sensibilities, attitudes, beliefs, dispositions and behaviors can lead to human suffering. That is why we have ethical guidelines and laws, to guide our clinical practice. What leads to universal morality, is the ability to reflect objectively about questions related to human dignity, respect, freedom and well-being. Just take yourself out of the picture for once.

I follow the Buddhist-philosophy (dharma), as a spiritual human being. It is a choice I made as an adult after many years of soul searching.  I grew up in a South African, Afrikaner-Christian home with my parents always telling us to educate and empower ourselves with information to make up our own minds about what kind of life we want to lead and person we want to be. I disagree with a lot of things that are fundamental to the Christian faith and the Afrikaner/Boer culture, but I value some aspects too. I believe in a lot of things, I have certain opinions and make certain decisions. But I believe that spirituality and my personal opinions and beliefs are private. I will not, nor should I force my opinions or beliefs on anyone else, or judge/condemn them for seeing the world differently. No one is perfectly ethical or moral, in every situation or context, but reflection, accepting your/other’s flaws and understanding why people do, say or act the way they do, will help this world become more tolerant, less judgmental and balanced where relative morality is focused on universal human well-being and “ubuntu” (human kindness).

A very inspirational speaker is Dan Ariely. I found his presentation  (especially the first few minutes) on “Our buggy moral code” very interesting and an eye opener to morality and health care.

“A man does what he must.
In spite of personal consequences.
In spite of obstacles, pressures and dangers.
And that is the basis of all human morality”
Winston Churchill


For PHT402 Professional Ethics Course

Week 1: Reflection


After reading all the blog posts and comments from my fellow course participants, I felt the need to reflect and consider the opinions expressed and respect the complexity of human connection and personal preference or perception. I would like to end the week’s topic of empathy off by reflecting on and summarising my thoughts, before moving onto the next chapter, morality.


Avatar - I see you

This week’s topic of empathy made me think of Avatar the movie,
with it’s central theme of connection and understanding.

“Oel Ngati Kameie” – I see you (I see into your soul, I understand you)


What surprised me most was the difference of opinion on empathy, perception of vulnerability and it’s role in the management of our patients as health care professionals and most importantly as human beings. Noam talked about the “scale of empathy” and stated that “empathy is balance”, which made me realise that empathetic engagement and human connection is a choice.  It made me reflect on the relationships I have my my little patients and their families.  I must be especially cautious of the interrelation of empathy and sympathy when working in the sensitive fields of physiotherapy, as there is a dividing line: your professional objectivity and role as therapist and health care provider.  Mary summarised this so beautifully by sharing her volunteer work experience in times of disability, pain, resentment, heartache, disappointment, loneliness and death.  Furthermore, I was inspired by and drawn to the well written blog posts by Jackie, Marna and Charde, discussing interpersonal communication and the importance of empathy in practice and life. Furthermore, I came to realise after reading Thomas‘ blog post how important it is to reflect and learn from past experiences in order to grow as a human being and become comfortable with “feeling” and connecting with others.


A few of the student’s blog posts and Wendy’s opinion on the usefulness and necessity of empathy in practice, really made me take a step back and understand that personality, therapeutic environment (context) and personal preference, all influence how therapists choose to connect, engage and communicate with patients.


I am still of the opinion that  empathetic engagement is context-specific and central to human connection.  It remains a choice of when, if, how and to what degree one displays empathy whilst maintaining professional objectivity and respecting patient-therapist roles and boundaries.  I believe that altruism is universal and natural, but using empathy as a communication skill to connect with others requires development and nurturing.  For me, it is an essential part of holistic patient management and care.


As a spiritual being, I have chosen the Buddhist-philosophy and follow the Dharmapada (“the path of Dharma”).
I found this quote from an ancient Sanskrit script inspiring:

“Resolve to be tender with the young; compassionate with the aged;
sympathetic with the striving; and tolerant with the weak and wrong.
Sometime in your life, you will have been all of these.”

Gautama Buddha


For PHT402 Professional Ethics Course 

Week 1: Empathy

“The great gift of human beings is that we have the power of empathy.”
Meryl Streep, actress

Is it even possible to find a more complex and misunderstood word? A word that bridges the gap between human experience, reactive emotion, compassionate thought and altruistic connection.

The idea of empathy was first described in the 1880’s by a German psychologist Theodore Lipps, who coined the term “einfuhlung” (literally, “in-feeling/touch”).  For me, this definition of empathy best encompasses the full meaning of the word in neutral context: The process of appreciating and understanding a person’s subjective experience while maintaining some degree of professional or personal distance.

As a physiotherapist or health care provider, having empathy is to be concerned with a much higher order of human relationship and understanding of your patients. For me, empathy has been a crucial and required altruistic communication skill as I am faced on a daily basis with overwhelmed and anxious new moms with their newborns, and scared, devastated and at times unrealistic expecting parents of babies and kids with special needs or medical respiratory problems. Our patients expect a lot from us and trust us with their vulnerability. We have to be careful of becoming too emotionally involved or invested in our patients’ lives and human experiences, as you can loose your professional objectivity and blur the patient-therapist boundaries. It can also lead to emotional burn-out by making you feel like you are responsible for your patients’ happiness and solving all their problems. I am of opinion that maintaining a healthy, altruistic but professional relationship with all your patients is key.  By being honest with sensitivity and compassion, listening and observing with all your senses and just taking the extra time to let your patients or their families speak or ask questions, really help to build a trusting patient-therapist relationship and human connection without sacrificing your professional objectivity.  Having mild empathy enhances every facet of holistic management and patient outcomes.

In this fast-paced world driven by quantity rather than quality, it often happens that we forget the importance of human compassion and understanding.  We have all heard or know of health care professionals with “poor bedside manners”. They often speak using medical jargon, talk down to patients or their loved ones, don’t make eye contact, rush through each consult or therapy session, brush off or interrupt patients asking questions, raising their concerns or discussing aspects of their lives.  Many health care professionals consciously choose not to interact with their patients on an emotional level, as they don’t see the point or are unsure of how to deal with it as vulnerability means uncertainty and they only want to focus on objectivity and what they can control. There is a fine line between empathy with professional distance, and sympathy with personal involvement.  I believe as human beings and more important as health care professionals, we have the ability and responsibility to expand our perceptions, lean into the discomfort of vulnerability and spend a little more time focusing on others in need by treating them with common decency and respect.  Remember, you cannot treat others with compassion if you are not kind to yourself first.

Now the controversy… Can empathy be taught? Some may argue that empathetic engagement in patient care or society can be taught… Some believe that it can be enhanced by various emotional intellect and communication skills training programmes and experiences. Others are of the opinion that empathy comes from altruistic human nature, that it is an inherent emotional communication skill that elicits compassion and sensitivity, as all humans long for connection… But it is still a choice, to engage or not to engage….  Where do you stand?

I’ll leave you with Alanis Morissette:

“…Thank you for seeing me, I feel so less lonely.

Thank you for getting me. I’m healed by your empathy…”

Blog Post: Week 1, themed “Empathy”, for PHT402 Online Professional Ethics Course