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.

 

Advertisements

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

Torture

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.

 

Moral courage

I’ve just watched the view on Science and moral questions on the week 2 page and read the page highlighted in Marna’s post which clearly explains the difference between ethics and morals.  A quick google for moral ethics in healthcare found some interesting papers but especially this one on moral courage.

Thoughts so far:

  • Morals are your own internal values/opinions which influence your actions.
  • The ethics of your society and professional community may not influence your moral values but will probably influence your actions!
  • Your moral courage will determine to what extent you are prepared to honour your own moral values/opinions when these conflict with the ethical framework as determined by your society, profession, place of work etc within which you are operating.

See this news story which highlights a culture in the UK NHS that strongly discourages some moral actions of its employees – NHS whistleblower Gary Walker ‘faced bullying culture’… would you be courageous enough to do the right thing in such circumstances?  I don’t know if I would have been….

Empathy – the human element?

We have just returned to civilisation after a holiday in the hills and it is extremely exciting to to see all the activity going on in all the course blogs.  There are some fantastic insights, links to related resources and some great conversations going on… I recommend you read Michael’s post to get a small insight into all of this if you haven’t already.

So I’m not a PT/Physio and so I don’t have that perspective (although I can try to empathise with you all!) however I have been a patient. I can remember one particular review appointment with my knee consultant following an ACL reconstruction many years ago. Rather than seeing the consultant himself I was seen by one of his younger assistants. The one thing I can remember from his review of my progress was his statement that my knee was now best kept under a desk rather than being used for anything active (I can’t remember the exact words used – but “under a desk” was something that stands out). He seemed to have made no attempt to understand me and the importance of my leisure activities, and hadn’t considered the implications of this medical advice on the rest of my life or how I might feel about that. Rather than get upset I took this as a challenge which I have enjoyed ignoring ever since. I can see that not everyone would respond to this situation in the way I have and that this assistant’s medical advice could have been much better if he had taken a little time to understand my lifestyle and offered advice which took this into account as well as the implications of the medical condition of my knee.

Image

(image from http://www.freevectorsdaily.com/)

On reading some of your posts, and coming from a background of being an engineer and computer geek I found myself thinking about if a computer was to replace a physiotherapist how this would operate in a clinical scenario. In my thought experiment this computer would be extremely professional in recording and analysing all the symptom data and returning a statistically most likely diagnosis and therefore an appropriate treatment plan. However would this computer be a good physio? In attempting to be professional and clinically detached are medical staff aiming to respond as a computer/robot would in these situations?

I think it is empathy which is missing the element that a computer/robot physio could never provide. The fact that we are human and can respond to another human through our understanding of what it means to be human as well as draw on our area of expertise as objectively as we can.

So as a patient here is what I am looking for in my physio:

  • Avoid making assumptions about me
  • Ask questions so you can understand me
  • Take time to listen and digest my responses
  • Compose your advice so that it addresses my life as well as my condition
  • Oh and be very knowledgeable and confident too!

Following your colleagues’ blogs using WordPress.com Reader

If you are logged in to your WordPress.com account when viewing the blogs of the other student’s of the ethics course you may have noticed a Follow link in the black tool bar at the top of the browser page. This Follow link allows you to add each blog to your WordPress.com Reader page.

follow

The WordPress.com Reader is an alternative tool to Feedly which you can use to stay in touch with what is happening on all the course blogs. If you want to explore this option then I recommend taking the following steps:

  1. Login to your WordPress.com account.
  2. In a new tab go to the ethics course portfolios page.
  3. Click on each student name to view their blog.
  4. Click the follow link in the toolbar at the top of the page to add their blog to your WordPress.com Reader.follow2
  5. Go through all the student blogs clicking to follow each one.
  6. View your WordPress.com Reader by hovering your mouse over the WordPress icon in the toolbar at the top of the page and clicking on Reader in the pop-up menu.follow4
  7. You will now see the latest posts listed with an extract and details of any comments etc.follow5

Hope this helps!