Greenfield Bruce, Jensen Gail M
Department of Rehabilitation, Division of Physical Therapy, Emory University School of Medicine, Center for Ethics Emory University, Atlanta, GA 30322, USA.
Physiother Res Int. 2010 Jun;15(2):88-95. doi: 10.1002/pri.481.
Physical therapy, like all health-care professions, governs itself through a code of ethics that defines its obligations of professional behaviours. The code of ethics provides professions with a consistent and common moral language and principled guidelines for ethical actions. Yet, and as argued in this paper, professional codes of ethics have limits applied to ethical decision-making in the presence of ethical dilemmas. Part of the limitations of the codes of ethics is that there is no particular hierarchy of principles that govern in all situations. Instead, the exigencies of clinical practice, the particularities of individual patient's illness experiences and the transformative nature of chronic illnesses and disabilities often obscure the ethical concerns and issues embedded in concrete situations. Consistent with models of expert practice, and with contemporary models of patient-centred care, we advocate and describe in this paper a type of interpretative and narrative approach to moral practice and ethical decision-making based on phenomenology. The tools of phenomenology that are well defined in research are applied and examined in a case that illustrates their use in uncovering the values and ethical concerns of a patient. Based on the deconstruction of this case on a phenomenologist approach, we illustrate how such approaches for ethical understanding can help assist clinicians and educators in applying principles within the context and needs of each patient.
物理治疗与所有医疗保健专业一样，通过一套道德准则来规范自身行为，该准则界定了专业行为的义务。道德准则为各专业提供了一种一致且通用的道德语言以及道德行为的原则性指导方针。然而，正如本文所论证的那样，在存在伦理困境的情况下，专业道德准则在应用于伦理决策时存在局限性。道德准则的部分局限性在于，不存在适用于所有情况的特定原则层级。相反，临床实践的紧迫性、个体患者疾病经历的特殊性以及慢性病和残疾的变革性本质，常常会掩盖具体情况中所蕴含的伦理关切和问题。与专家实践模式以及当代以患者为中心的护理模式相一致，我们在本文中倡导并描述一种基于现象学的道德实践和伦理决策的解释性和叙事性方法。在一个案例中应用并检验了研究中明确界定的现象学工具，该案例展示了它们在揭示患者价值观和伦理关切方面的用途。基于用现象学家的方法对该案例进行的解构，我们说明了这种伦理理解方法如何能够帮助临床医生和教育工作者在每个患者的具体情况和需求背景下应用原则。
