Ethical reasoning in physical therapy and occupational therapy.

The purpose of the study was to describe and then compare ethical dilemmas reported by eight physical therapists and eight occupational therapists. A co-operative research method was adopted with the therapists participating in the analysis of the transcripts of the interviews. The analysis was carried out using a 'multiple' readings methods taken from hermeneutic phenomenology. Results showed that the context or setting of the dilemma had a major effect on the therapists' reasoning. Features which emerged from the context were the site of the dilemma, the work group, the patient group and the hierarchical or power relations in operation. Physical therapists and occupational therapists showed differences in reasoning style with the former more likely to adopt a diagnostic or procedural style, and the latter a narrative style. Dealing with ethical dilemmas was found to be a skilled and stressful aspect of practice. Capacity to deal with the dilemmas was negatively influenced by uncertainty of outcome, emotional sequelae of the event, and social pressure to behave in certain ways. Positive influences included previous experience with similar dilemmas, time for reflection, and support from peers.