education ethics open access pht402 physiotherapy technology

An international project in professional ethics

Earlier this year I began working with several colleagues on an international module in professional ethics. We’re going to spend 2015 collaboratively designing a module that students from a variety of undergraduate physiotherapy programmes can complete, in both online and face-to-face contexts. The project builds on the work I’ve done previously as part of my PhD research (these notes are in progress), as well as on a pilot project I completed in 2013.

We currently have collaborators from several countries, including Brazil, Belgium and South Africa, and I’m hoping to get a few more during the workshop I’m running on Open Online Courses at the WCPT congress in Singapore in May. If you’re interested in the idea of collaborating on an international course in ethics, please let me know.

You can read more about our plans at the project website.

pht402 students

The mind of the innocent – student poem

Sometimes a student submits something to me that is so different to what I usually get that I feel a need to share it. This is a contribution by one of our 4th year students, who has kindly agreed to have her work shared here.

The morning after loss is more than obvious
The sombre pierces echoes of the silence
Laid to rest: my buried innocence

Can’t digest the truth I’m told: no more tears as I sit down
The nightmare’s just beginning
The emotions in me die when sanity prevails
Daylight brings some hope but it doesn’t last at all
To heal the wounds time left for me

You can’t change what already happened
I guess that’s the burden I’ll have to live with
Nothing will ever compensate for what I’ve suffered
What’s left for you to offer?

Pain and suffering are blood brothers
Keeping each other away from the cure
Feeling perfect in the short run; dying further in the long term
Hiding from the truth I know, if I put on a facade they won’t know
How I really feel

A field of innocence contains broken flowers
I guess we’ll miss you
After 24 hours

Shameemah Hartley

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PHT402: Final thoughts and moving forward

This is a short review post for the PHT402 Professional Ethics course that was recently completed by physiotherapy students from the University of the Western Cape and qualified physiotherapists who participated through Physiopedia. We believe that this is the first time that a completely open, online course in professional ethics has been run as part of a formal undergraduate health care curriculum.

2049233526_358678b16eIn total we had 52 UWC students and 36 external participants from around the world, including South Africa, USA, United Kingdom, India, New Zealand, Estonia, Saudi Arabia and Canada. The context of the course, objectives, course activities and participant learning portfolios are available on the project page, so I won’t go over those again other than to say that the course was aimed at developing in students a set of attributes that went beyond simply teaching them about concepts in professional ethics. In other words, it was about trying to change ways of thinking and being, as opposed to teaching content. It’s too early to say whether or not we achieved this but if nothing else, we do seem to have made a significant impact in the personal and professional lives of some of the participants.

One of the most interesting things about this course has been the enormous variety of perspectives that emerged, which on a personal level have driven my thinking and reasoning in different directions than if I had engaged with the topic in isolation. From one of the participants, “…it brings on thoughts that I find unsettling“. This is a good thing. One of the points of the course was to put people into those contested spaces where the “right” and “wrong” answers are ambiguous and context dependent. The more we explore those spaces within ourselves and with others, the better prepared we’ll be to navigate difficult ethical situations in our professional practice.

Running the PHT402 Professional Ethics course in this way has been an enormous learning experience for me and many lessons emerged during the course that were unanticipated. Here are some of the things we did that I’ve never done before and which challenged us to think about different ways of teaching and learning:

  • Participants were mostly unfamiliar with how the internet works and so had no experience with following the work of others. We needed to give very explicit instructions regarding setting up blogs and following other participants. Email support was extensive and many participants were regularly in contact. I learned that email is still an essential aspect of working digitally.
  • Participants were geographically distributed and most had never had any blogging experience. We needed to figure out how to teach them how to blog without being able to get them all into a classroom. We wanted not only to teach them how to simply write blog posts but to also include embedded media, linking to other participants, using tags and categories. We wrote a series of posts that were designed to not only give instructions on how to blog but also how to write engaging posts on the web. Every participant was encouraged to follow the participants to ensure that they were exposed to this input.
  • It wasn’t possible for the facilitators to comment on every post of every user (although I gave it my best shot) but we had to make sure that everyone got feedback of some kind on their posts. We designed a form in Google Forms and asked every participant to review the work of 3 other participants. Then we aggregated that feedback, which was quantitative and qualitative) and sent it to each participant. In this way, we ensured that everyone got feedback in one form, even if they weren’t getting comments on their posts.
  • It’s difficult to give a grade (this was part of a formal curriculum, so grades were unfortunately a necessity) for participants’ perceptions of topics like equality, morality and euthanasia. We decided the students would be graded on the extent to which they could demonstrate evidence of learning in their final posts. We said that this could be in the form of identifying personal conflict and resolution (one of the aims of the course), linking to the posts of others with analysis and integration of those alternative ideas (learning collaboratively), use of the platform features e.g. tagging, categories, Liking, Commenting, etc. (using technology to enable richer forms of communication). I created a rubric that is more extensive than this list, but it just goes to show that the assessment of a course like this needs to be about more than simply asking if the student covered the relevant content.

Now that this course has been completed, I plan to do research on the data that was generated. This was always part of the project and as such it had ethical clearance from my institutional review board from the outset:

  • I designed the learning environment using principles that I had developed as part of my PhD project. This course could be seen as a pilot study aimed at further testing those design principles as a way of developing a set of Graduate Attributes in an online learning space. To this end I’ll be doing a series of focus groups to find out from students whether or not the course objectives were achieved.
  • In addition to the focus groups I’d like to try and triangulate that data with a content analysis of the blog posts and comments that were generated during the course. I’ll qualitatively analyse the course outputs that were created by participants.
  • I’d like to survey all of the participants to get a general sense of their experiences and perceptions of having completed a course that was very different to what they were used to from a traditional curriculum. I’d like to find out if offering a course in this way is something that we should be looking at in more depth in our department.
  • During the course, a significant number of connections were made between people on the open web. I’d like to use social network analysis to see if there’s anything interesting that emerged as a result of how people connected with each other. If you have any suggestions for methods to analyse a set of blog posts on WordPress, please let me know.
  • Finally, I want to interview the other facilitators who helped me to develop the course and who were based in different countries at different times in the project. I want to see if there are any lessons that could be developed for other, geographically dispersed teachers who would like to run collaborative online courses.
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PHT402 Ethics course: Developing an online professional identity

This post was written for the participants of the #pht402 Professional Ethics course. For many of our participants working online has been a new and interesting experience but for most it will probably won’t progress much more than that. This post is intended to highlight how the blogs that have been created as part of the course can form the foundation of an online professional identity that can be carried forward as evidence of learning in a variety of contexts.

digital_identityIn an increasingly connected and digital world, it often seems that too much is happening, too quickly. Every week another online service, app or device is competing for your time and it can be overwhelming to decide where to focus your attention. Even in our professional lives as clinicians or academics, there’s an increasing sense that “being” online is important, even if we don’t know exactly “how” to be, or “where” to be. There is a move towards the sharing of clinical experiences and resources that can add value to your professional life, if the available services and tools are used effectively. The clinical context is so dynamic, complex and challenging that we owe it to ourselves, our colleagues and our professions to share what we know.

The Internet offers a perfect platform for this professional interaction, particularly through the use of social media. “Social media” is an umbrella term for a range of online services that facilitate the creation, curation and sharing of user-generated content. It is increasingly being tied in to mobile devices (i.e. smartphones and tablets) that make it easy to share many aspects of our personal and professional lives. Some examples of the types of technologies that come under this term are: blogs (like we’re seeing in this course), microblogs (e.g. Twitter), wikis (e.g. Wikipedia, Physiopedia), podcasts, discussion forums, virtual social worlds (e.g. Second Life), gaming worlds (e.g. World of Warcraft) and social networks (e.g. Google+ and Facebook). As you can see, the term “social media” covers a lot of ground, which is why it’s sometimes difficult to figure out what exactly someone means when they talk mention it.

While the main theme of this post is to highlight the benefits of creating and maintaining an online professional presence, bear in mind that it’s not enough to simply “be” online. The main advantage of having an online professional identity is that it allows you to interact and engage with others in your field. Twenty years ago, academics and clinicians could only rely on the (very slow) process of publication and citation to learn about changes in the field. Now, with the affordances that the web provides, crafting a professional online identity can happen very quickly. However, it’s the interaction and engagement through conversation and discussion that builds reputation and a sense of presence, rather than simply “being there”.

You might be feeling that this is all a bit overwhelming and that you don’t have possibly have the time to get involved with all of these services. And you’d be right. Try to think of this as a developmental process, one that is going to take time to evolve. You didn’t emerge from university as a fully-formed, well-rounded clinical practitioner or researcher. It took time for you to develop the confidence to engage with colleagues, to share your ideas and to contribute to professional dialogue. Establishing an online identity is no different.

Whether you decide to continue updating your blog, or to start tweeting, the point is that you start somewhere, and start small. As your confidence grows, you’ll want to begin experimenting with other services, integrating them with each other and building them into your workflow. This is the most crucial part because if you think of this as just another thing you have to do, or another place you have to go, you’ll find yourself resenting it. Build a foundation in one space at a time, and only use services and applications that you feel provide you with value.

In the beginning, you may feel more comfortable “lurking” on social media sites, listening to the conversation without really contributing. This is OK and is likened to a form of Wenger’s concept of legitimate peripheral participation. Over time, as you gain confidence you may begin to feel that you have something to say. This may be as simple as posting your own content (e.g. a tweet, a blog post, a status update), sharing the content of others, or agreeing / disagreeing with something that someone else has said. Whatever it is, don’t feel pressured to say something profound or clever. Just give your sincere input to the conversation.

In case you’re wondering if there are any rules or regulations in terms of using social media as a health care professional, that’s hard to say. Many organisations and institutions do have a set of policies that can inform practice when it comes to employees using social media, although it’s hard to say if these are rules or guidelines. One of the biggest difficulties is that as a health care professional, the public often perceives you as always being “on duty”. A physio is always a physio, whether you’re working or not, which makes it difficult to determine what is appropriate to share, and when. The following list of health-related social media policies may help you to tread the fine line between your personal and professional online identities.

Developing an online professional identity and presence is an essential aspect of modern scholarship and increasingly, clinical practice. Not only does it allow you to connect and engage with researchers, academics and other clinicians in your field of interest, but it helps to develop your professional reputation by giving you an international platform to share your work and your ideas.

There are many services and platforms already available, with more becoming available all the time. While it’s not necessary to have a presence and to participate in all possible online spaces, it helps to be aware of what is available and how the different services can be used in the development of your own professional identity. Finally, while developing a professional presence is advisable, be aware that what you share and how you share will have as much of an impact on whether your share or not. There are some guidelines that are particularly relevant for health care professionals and researchers, but even then, the area is under such rapid development that it’s difficult for institutional social media policies to keep up. If in doubt, always check with your employer and colleagues.

curriculum ethics pht402 social media

PHT402: The last independent act?

This is my fifth contribution to a series of weekly posts related to the #pht402 Professional Ethics course. This week’s topic asks if assisted suicide is ever OK? I thought it would be an interesting question to ask health care professionals and students what they thought about the possibility of a legal framework that enabled the possibility of assisted suicide.

dying with dignity

Until I watched this documentary that Marna shared, I believed that my thinking was pretty fixed with regards the topic of assisted suicide. Terry Pratchett explores assisted suicide as something that he is considering as a result of having Alzheimers. It’s a wonderful video that is at times sad and at times uplifting and empowering. What I liked most about the documentary was that several different alternatives were explored. It didn’t feel like an advert for Dignitas and didn’t try to glorify the act of assisted dying. I felt it was an honest and authentic exploration of the topic, which made me think that perhaps I’m not as committed as I thought I was.

cq4e889cf3However, instead of getting into the details of the topic and considering that this is the last week of the course, I’m going to cheat a bit and dodge this last topic. Perhaps what I offer instead will be a bit more provocative and off-the-beaten-track. In a few years time many of the questions that were raised around assisted dying will be replaced by others that are no less controversial – probably more so. I believe that in a few years we’ll figure out a way to cheat death, either through finding a cure for aging (see video below) and most other illnesses through the medical application of nanotechnology, or by moving our minds from a carbon-based substrate (i.e. a brain) to a silicon-based substrate (i.e. a computer). So, I’m not worried about losing the function of my physical body. It’s my mind that is most important to me and I hope that by the time my body is ready to go (assuming we haven’t cured aging by then) I’ll have a chance to upload my mind onto another platform.

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PHT402: What is the value of a human life?

This is my fourth contribution to a series of weekly posts related to the #pht402 Professional Ethics course. This week’s topic is specifically about torture, but the general principle concerns the rights of the individual vs the rights of society, as well as asking about the relative value of a human life.

free-humanityI’m going to begin by answering the question in the title: “It depends on who’s life you’re talking about”.

When preparing this course I thought that the topic of torture could be used to move a conversation beyond the specific example of torture and look at the broad principle, which concerns the rights of an individual human being weighed against the rights of society. Or, to put it another way, how do we ascribe value to human life? I hadn’t really considered the possibility of a physiotherapist being asked about a patient’s physical condition in order to determine whether or not they could be hurt by someone else. It shouldn’t have surprised me though, since in South Africa we have a long history of our medical profession being complicit in human rights abuses that include torture (as highlighted in one of the readings for this week).

Even though the topic of torture has been questioned as part of this course, I think that the principles that emerged from the week’s discussions are relevant to other areas of our practice. For example, how many lives is one life worth? What value do we place on human lives? Are all human lives valued the same? These questions bring us back to the idea of equality and morality. Are we all equal? In what ways are we equal? How different are our boundaries of what is “right” and “wrong”? Is torture ever the “right” thing to do? The United Nations says it never is. But, there are times when your personal morality might say that torture absolutely is necessary. Wendy expressed this nicely when she asked about actions that may be morally wrong but which are morally justifiable.

I think that these are interesting questions that don’t need to be answered, but talking about them may help us to figure out some things about ourselves.

Naom makes two good points in her post, which are that your thinking around this topic is influenced by how you value human life, and whether the value of lives from those within your group is higher than those outside of it. As noble as we like to think we are, we do inherently place more value on certain lives than on others and this is where the importance of context comes in. My daughter’s life is more valuable to me than any other child in the world because she is my  daughter. She doesn’t need to have any special skills, knowledge or potential in order for me to value her more. As much as I like to think that we’re all equal, I have to acknowledge that we don’t all have the same value.

Um’r makes the point that for thousands of years, human beings have consistently looked for more and more ingenious ways to inflict pain and suffering on each other. He also links this week’s topic back to the questions of equality and morality, and then goes on to day that as much as each of us may abhor violence towards others, he asks how far he would go in order to protect those closest to him. This is challenge, to live the life we believe is right, even when faced with difficult choices. If every life is equal (Janine has a simple exercise that explores this), then torture can never be OK.

In the comments on Janine’s post there’s a question about how age could be a deciding factor in determining if a life could be sacrificed to save others.  In one context, age may be an appropriate reason to sacrifice a life but not in every context. For me, this is one of the most difficult skills that we need as health care professionals…the ability to modify our decision making processes depending on the unique context we find ourselves in. There are no universally correct answers to morally ambiguous situations.

Everyone I’ve read so far has focused on the military use of torture, but what about the other reading that briefly looked at the use of torture (or at least complicity in it’s application and cover up) by medical professionals? Tony has explored this by asking how medical professionals can be involved in torture.

I think that one of the most interesting aspects of Week 4s topic has been the emergence of side topics…conversations that were peripherally associated with torture but which became something else. Discussions about the value of life, morality, equality, moral boundaries, etc. all began happening in the comment threads, which was great to read. I think it really highlighted one of the benefits of a course with weak or flexible boundaries and participant-led discussion.

Finally, I’m going to point you to Chantelle’s blog, where she did a great job in relating the week’s broad topic to the South African context, as well as providing a reflective overview of the posts from Week 4. She opened her first post with this quote and I’m going to end with it:

The argument cannot be that we should not torture because it does not work. The argument must be that we should not torture because it is wrong.

ethics pht402 physiotherapy

PHT402: Equality and discrimination

This is my third post as a participant in the #pht402 Professional Ethics course. The topic for this week is equality and whether or not we really are equal in a society that discriminates on many levels.

It’s important to understand that equal in this context means equal before the law. No-one is suggesting that we should all be equally thin, smart or wealthy. It simply means that, as far as the law is concerned, we’re all going to be treated equally. Except that we’re not.

I’ve been following the trial of George Zimmerman in the shooting of Trayvon Martin over the past few weeks because I think it highlights how deeply the issue of race and discrimination goes in our global culture. I’m not going to rehash all of the details because that’s been done by many others but I do think that Martin Bashir (see the video below) presents the only facts that really matter.

Trayvon Martin was identified as a person of suspicion because he was black. And the way in which he was portrayed by most of the mainstream media highlights the disturbing way in which a black victim is seen. In South Africa we still see perpetrators who are given heavier sentences when the victim is white. How are we still here? After everything we’ve been trying to do since 1994, how are we still in a place where the colour of your skin not only determines your access to health care, education and social mobility but also how you’re treated after you’ve been murdered.

In the topic presentation for this week, Jay Smooth presented his views on responding to racism. I found a follow up talk that he gave at TEDxHampshireCollege, where he discusses the issue in more depth:

The Constitution promises us that we’re all equal. But we’re not.

Another area where this is blatantly obvious is on the issue of LGBTI rights in South Africa. Even though on paper we’re among the more progressive countries in the world when it comes to “gay rights” (whatever that means), it’s clear that we have a long way to go toward the realisation of those rights. Violence against homosexuals in a country dominated by traditional values continues to be under-reported and unrecognised. Even in the supposedly liberal academic institutions we see evidence of homophobia and hate crimes against those who love members of the same sex. Seriously? Considering the massive problems we face in this country around issues of poverty, corruption and completely dysfunctional education and health systems, people still have the time and energy to worry about who’s sleeping with who.

There is some acknowledgement that this is a problem, with officials in Cape Town receiving special training to deal with hate crimes against gays and lesbians. There is also a recognition that the current legal infrastructure doesn’t isn’t designed to effectively manage the problem, and government is in the process of reviewing the legal process for those accused of hate speech, and xenophobic and homophobic attacks. Our Constitution guarantees all of us the right to be treated with dignity and respect, by virtue of the fact that we’re human. Except some of us seem to think that the colour of your skin or your sexual orientation excludes you from the right to dignity and respect.

OK, so that’s a lot to take in and I’m not going to do an analysis of it. I just wanted to make the point that equality is an ideal that we strive for because it is right for everyone to be treated with dignity and respect. You may not be like me in every way but you are deserving of the same love and respect that I want for myself.

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PHT402 online course accreditation

The #pht402 Professional Ethics course has just been accredited by the South African Society of Physiotherapists and Health Professions Council of South Africa for 6 Level 2 Ethics CPD points. If you are a South African physiotherapist and would like to take part in the course, please register here before 9th August.

Image from opensourceway's Flickr stream
Image from opensourceway’s Flickr stream

Over the past few weeks I’ve been running an open, online course in Professional Ethics for my 3rd year students, in collaboration with Physiopedia. Check out the project page for the details of the course, including the context and background. I also received ethical clearance from our institutional review board to study the process and outcomes.

One of the major decisions we made was to invite qualified physiotherapists to participate as well. We wanted to encourage interaction between our students and the “real world”, that intangible place we say we’re preparing our students for. In return, participants external to the university would receive a badge from Physiopedia. These badges are compatible with Mozilla’s Open Badge standard and so have value outside of the Physiopedia ecosystem.

Until recently the course was only an interesting experiment among our 3rd year students and the 26 international physiotherapists who are also participating. However, I’m now very happy to announce that the SASP and HPCSA have accredited the course for 6 Level 2 Ethics CPD points. They had an additional requirement for participants to write a short test at the end but other than that, the course was accepted as is.

By accrediting the course the SASP and HPCSA have given this method of learning a degree of legitimacy that I find really exciting from two organisations that I think are traditionally quite conservative. It’s one thing for it to be recognised as an interesting research project and quite another for the professional bodies to recognise it’s potential to provide learning opportunities for geographically distributed professionals. A significant challenge for qualified South African physiotherapists obtaining their annual Ethics CPD points is that the courses are most often only offered in major city centres (requiring travel and sometimes overnight accommodation) and the registration fees are usually quite high. Our course is online and self-paced, which acknowledges the unique time constraints of individuals, and is free.

Now that we’ve set a precedent, we’ll offer the course every year and try to build a model for physiotherapy education for appropriate subjects through distance learning. This has potentially massive implications for the profession in terms of:

  • Moving learning away from the classroom, which will impact on physical space requirements
  • Connecting the university to health care professionals at a global level, bringing in many unique perspectives from “the real world”
  • Introducing a host of digital and information literacies for participants
  • Emphasising a student-centred, self-directed approach to learning that empowers learners to take control of their learning
  • Opening up further opportunities for collaboration between academia and the profession

Watch this space for further details. On a related note, I’ve also entered the course into the Reclaim Open Learning Contest, which is being run by MIT. I’ll be sure to post the outcome here.

ethics pht402 social media technology

Strategic blogging in the PHT402 Ethics course

This post is intended for the participants in the #pht402 Professional Ethics course who would like to take a more strategic approach to their blogging. By using a few strategies suggested here, you may find that it’s easier to make the best use of your time when preparing your posts for the course.

One of the difficulties you may come across when blogging regularly is finding the time to regularly reflect and write for this course. Since this module is allocated a slot on your timetables, I suggest that you use that time to work on the course. Even if you don’t have regular internet access, you could use the time to read content that you’ve downloaded, make notes, draft reflections, and discuss the topics with your peers on campus. The point is to put aside time in the week to focus on the module and then use that time effectively, even if you’re not actively blogging.

However, when you do sit down in front of the computer, you want to make sure that you spend your time writing, rather than trying to figure out how to use the platform. Remember that even though the course is designed so that you can progress through the topics at your own pace, there is still an endpoint and it doesn’t make sense for you to spend time on the technical aspects of blogging. There is no one keeping track of what you’ve done and when you did it so you will need to create your own schedule for working and then take responsibility for keeping to that schedule. The more familiar you are with using WordPress, the more likely it is that you can use your time effectively. Here is a screenshot of the Posts page, highlighting the common elements that you can use to manage your posts.

Posts ‹ -usr-space — WordPress - Mozilla Firefox_005
Screenshot showing some of the important areas in the index of posts, which you can use to more effectively manage your writing.

I strongly suggest that you begin drafting your reflective posts as soon as you can. Create draft posts for each topic (see image below) immediately and then work on those drafts over time. Every time you visit your blog, open your drafts and add new ideas, links to resources, links to other participants’ blog posts, images, etc. When you read something in the WordPress Reader and you want to incorporate it into your next post, copy the link to the post you want to reference and paste it into your draft. This way you can build up your reflective posts over time, rather than feel like you have to write it all overnight. You’ll also find that your thinking may change as you engage with others, and that something you wrote a weeks previously doesn’t feel quite right anymore. The Save Draft button is in the top right corner of the post.


Use the Quick Edit feature of WordPress to make simple edits to the elements of your post without having to load the whole page (see image below). This feature becomes visible when you move your cursor over the post title in the index of posts. You don’t have to click anything to make it appear, just hover your mouse over the text to bring up the menu, and then click on Quick Edit.

Screenshot showing the different post elements that can be edited using the Quick Edit feature.
Screenshot showing the different post elements that can be edited using the Quick Edit feature.

I often find that when I’m in a writing frame of mind I can get through two or three posts in one sitting. Or, I write the posts on the weekend or late at night, which is when most of the subscribers to my blog are probably away from their computers. Since I want to make sure that as many people as possible read my posts it doesn’t make sense to publish them at those irregular times. In cases like that, you may want to schedule your posts so that they’re published at certain times or on certain days.

Considering that you want as many people as possible to read your posts, you should consider linking a Twitter account to your blog. This would allow WordPress to automatically push your blog posts to your Twitter feed, which would increase the chances of the post being seen and read by your followers. It also means that your Twitter followers could Retweet the original tweet, thereby increasing exposure to your post.

Another aspect of the course that you may find is taking up a lot of time is interacting with other participants. When I comment on someone’s blog posts, I always tick the “Notify me of follow up comments” box. This means that when someone responds to something I’ve said, I get an email that lets me know. However, there’s another way to do it. There’s a notification icon in the top right hand area of your blog, which is coloured orange when you have notifications. See the screenshot below for an idea about how to quickly respond to comments.


That’s it. Just a few suggestions that may help you to be more productive with your blogging and to make effective use of your limited time.

ethics pht402 physiotherapy social media technology

PHT402: Morality, belief and behaviour

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.

nothing-written-in-stone-relative-moralityWhat 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.