Ethics course review post

I have just published a post on Physiospot that reviews the ethics course and quotes several of your blogs.  Thank you for giving me permission to do this!

Read the Ethics course review post.



Euthanasia story from Salt Lake City

We are staying in Salt Lake City, Utah, USA and happened across this sad story this week. This describes how a professor who specialised in medical ethics and euthanasia suddenly had to face these issues when her husband was injured in a cycling accident  and how this influenced her thinking about the issue:

New York Times – A life-or-death situation

If you are interested in this story the couple kept a blog about their experiences of the four years following the accident and and how he sought to overcome his disabilities and continued to find value in his life.

“The real challenge for me has been in trying to expand my mind enough to comprehend my own catastrophe without letting it become that way… …I’ve tried to just let it be part of me, part of who I am becoming, and to always keep in mind how extraordinarily much I’ve gained, not just what I’ve lost.” Brooke Hopkins

Unfortunately Brooke Hopkins passed away July 2013. The Salt Lake Tribune documents the final chapter in the story…

“autonomy is way more complex than you ever could have imagined — and this is true not just for Brooke but for every person who faces the end…. You can’t assume that “all choices are alike, so you have to be alert to what someone deeply wants.” Margaret Battin


From reviewing various blog posts we seem to agree that torture is never justifiable, which is a position I agree with.

Unfortunately it seems that some medical professionals do not agree and are even prepared to use their skills to assist in interrogation (see NY Times article on a Red Cross report into the CIA interrogation of suspected terrorists). It is unclear from this report whether any of these medical professionals were physiotherapists. It is not impossible to believe that a physiotherapist was involved. If this were the case do you feel that such a physiotherapist should be punished by your professional body?

I also found this philosophical discussion of the ethics of medical involvement in torture very interesting in its exploration of the definition of torture which helps clarify that normal physiotherapy treatment shouldn’t be considered torture… however are there circumstances where this definition may apply? e.g. the treatment of an uncooperative elderly patient?

“Torture is the deliberate infliction of pain or other severe distress by one sentient being on another who is in captivity and involves using that being as a means to an end to which the being has not consented”

This paper also raises 3 ways in which the medical professional may be involved

(a) he attempts to heal the victims of torture;
(b) he himself engages in torture either by advising or by actually carrying it out;
(c) he examines possible victims knowing or suspect-ing that torture will follow.

There may be ways of involvement which we can justify such as option A and others ways of involvement which are less clear cut such as option C. A potential scenario for option C for a physiotherapist could be where you are asked to examine a prisoner to determine whether they could weight bear on an injured leg, where you suspect that enforced standing could then be utilised as a torture technique. In such circumstances what would you do?  Do you diagnose that the prisoner could not weight bear even when your professional opinion would be that they could?

Equality in healthcare

Treating all patients equally whatever race, religion, disability, gender etc. seems like the obvious and easy answer to dealing with equality in healthcare. What wasn’t so obvious to me was that to address equality we may need to think about our usual approach to working with our patients and the assumptions we may make in taking this approach.

I found the Stonewall Healthy Lives website very enlightening as it describes some the perspectives of lesbian, gay and bisexual patients regarding their healthcare needs. These raised many issues that I wasn’t aware of. For example the images used in promotional information provided in the clinic (posters/leaflets etc) can help patients feel like they are accepted or not before they even meet the health care professional.  Another example is it is important to try to ask open-ended questions, such as “Have you got a partner?” rather than “Are you married?” when gathering patient information. The patient should feel comfortable bringing their partner to a consultation or treatment session, so you should encourage this with appropriate language “Would you like your partner to accompany you?”.

Developing an approach to patients that accounts for all these issues isn’t necessarily obvious or straightforward and so it seems to me that aspiring to provide equality in our care requires us to educate ourselves about the needs and issues that relate to our patients.