This is my post for the second week as a participant in the #pht402 professional ethics online course. This week we’re exploring the concept of morality and where it comes from, and it’s role in our professional practice.
The way that I understand the difference between ethics and morality is that ethics is what guides you in the context of your professional organisation and possibly the laws in your country (i.e. it is an external motivating influence), while morality is what you believe to be right in the context of your personal being (i.e. it is an internal motivating influence). In addition, morals are the ever-changing social rules about what a community or society decides is OK, and ethics is an attempt to determine a universal standard of good and bad no matter what the context.
I think that ethics as a philosophical school of thought is about trying to get to the root of good and bad, something that holds true for the majority of people (and animals if you believe that animals should be valued on the same level as humans). On the other hand, Ethics as it relates to my professional practice is a set of guidelines that are provided by the professional bodies in this country, for example the Health Professions Council of South Africa and the South African Society of Physiotherapy. These organisations give me a set of rules that tell me what I must do in my practice, as opposed to what my morals may tell me to do.
I think it’s important to have your professional behaviour moderated by an external body because health care practitioners are moral agents who make decisions about patients based on personal connections and relationships with them. Values, beliefs and emotional factors are embedded within the interactions between health care providers and patients, suggesting that these interactions are more than the exchange of information. This active engagement with, and acknowledgement of, the emotional response to patients’ stories can help to develop the moral agency that is a necessary part of ethical clinical practice (Delany et al, 2010). However, if there are moral conflicts between patients and therapists, then the interactions will suffer because our behaviour is influenced by what we believe. Better to have a set of rules that you must follow, regardless of what you believe.
Having said that, Tony has made a good point about the moral courage that is necessary when the “rules” suggest a method of practice that you know to be wrong. Would you stand up for a patient when the rules are telling you to step down? This is easier if you believe that right and wrong are discrete entities and that there’s a line dividing them. However, the moral grey area is far more difficult to navigate and needs a far more complex set of skills than to simply choose one side or another. Jackie has written nicely (using Batman) about the moral grey area that exists, whether we choose to accept it or not.
Charde makes a great point about belief systems that impact on behaviour, but isn’t specific about the nature of the belief system. In other words, it can be a religious framework but it doesn’t have to be. This raises interesting questions about people who derive their sense of “goodness” from religion, but more so about those who believe that goodness is essentially determined by belief in a god. Do you have to be religious to be good? Or, do you simply need to have a different framework that happens to align with the tenets of most religions e.g. it’s better to not kill each other, it’s better to not steal from others, etc. Do you need to have a god watching over your shoulder to be good?
Lauren raises some interesting questions from the point of view of a Christian and describes how her particular belief system (i.e. Christianity) has strongly informed her sense of right and wrong. She also suggests that when you learn about a patient’s background, your perception of them is immediately altered, depending on what you personally believe. How do you balance what you believe (e.g. the patient is a bad person and you don’t want anything to do with them) and your professional obligation (e.g. you have to treat the patient because every citizen has a right to health care)?
In another point of view, Wendy talks about the role of other forms of literature and media on the development of her moral framework. I agree with all of it, although I’d disagree with one aspect by saying that music most definitely has had an influence on my concepts of right and wrong. I’d say that contemporary cultural influences in the form of music can present interesting ethical dilemmas, from the glorification of violence and drug use, to the subordination of women.
What I’ve taken from this week’s topic was the huge variety of influences that impact how I think about the world. From interactions with family and friends, to the books I’ve read, movies I’ve watched, church services I’ve attended, music I’ve listened to, personal reflections, and countless other interactions over the course of my life, my sense of what is right and wrong continues to morph and adapt. As I learn more about the world and about myself, the larger the moral grey area seems to become.
- Delany, CM, Edwards I, Jensen GM, Skinner E: Closing the Gap Between Ethics Knowledge and Practice Through Active Engagement: An Applied Model of Physical Therapy Ethics. Physical Therapy 2010, 90:1068-1078)
- Health Professional Council of South Africa – Professional ethical guidelines
- South African Society of Physiotherapy – Code of Conduct