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.

 

 

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 equality, racism, sexual 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

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For PHT402 Professional Ethics Course: Week 6: Overview

 

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.

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

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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

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For PHT402 Professional Ethics Course