Ethical issues related to the choice and duration of treatment by Maltese physiotherapists

Abstract

Physiotherapy is a relatively young healthcare profession that offers the assessment, diagnosis and rehabilitative treatment of a vast range of conditions. The practice of Maltese state registered Physiotherapists is legally regulated by the Laws of Malta, in conjunction with the Council for Professions Complementary to Medicine. Within these boundaries, state-registered physiotherapists exercise a professional autonomy that includes deciding what treatment techniques to apply and the length of such treatment. The local health and social care sectors are currently undergoing great change, resulting in an increased demand for an excellent and consistent, yet efficient and practical service. In relation to physiotherapy, the heart of such an endeavor resides in helping physiotherapists to address questions that arise when treating clients. Often these questions go beyond professional behavior and clinical decision-making, as the physiotherapist must also deal with values, rights and responsibilities. Both physiotherapy and bioethics share the same fundamental aim of improving quality of life. Yet, to date, there has been surprisingly little bioethical discourse directly concerning physiotherapy service. Then again the physiotherapist does not usually deal with sensational and prominent cases much beloved by the media such as beginning-of-life and end-of-life issues, but achieves his/her aims through a planned combination of short and long-term goals. Furthermore, the changing role of the physiotherapist’s professional status has led him/her into relatively uncharted moral territory. In comparison to physicians, little is therefore known about the bioethical perception of the physiotherapist; his/her conscious awareness of ethical problems encountered in the clinical setting, and how these issues are routinely resolved to some degree or other, as they must be in order to provide the required service. A major dilemma in physiotherapy concerns the effectiveness of therapy influenced by the choice and duration of treatment. Without introspective bioethical analysis of this reality, it becomes difficult for the physiotherapist to grow professionally beyond the basic knowledge and rule-based system within the contemporary health care model. This also has to do with the sharing of knowledge with colleagues, physicians and the rest of the multi-disciplinary team. This thesis will take present factors that influence physiotherapists in this regard, from a bioethical perspective. Factors will revolve around: 1. the international and local, legal and regulatory context, 2. the physiotherapists’ role, moral perspective, professional behavior, rights and duties, 3. the patients' role, moral perspective, rights, duties and obligations, 4. the morality of the interaction between the physiotherapist and the patient, 5. the surrounding environment in terms of inter-professional relationships, 6. the surrounding socio-political environment, in terms of limited resources, 7. moral considerations specific to particular patients who fall within the umbrella term of ‘vulnerable groups’. Although the thesis will not evaluate clinical competence, it is hoped that the resulting bioethical analysis will seed a more holistic professional amelioration through the structured clarification of ethical issues inherent to the physiotherapists’ choice and duration of treatment, thereby leading to a morally higher standard of physiotherapy service quality.