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== What are Morals ==
== What are Morals ==
Morals are defined as "standards of behaviour; principles of right and wrong"<ref> Oxford Dictionaries,  Oxford University Press, https://en.oxforddictionaries.com/definition/moral (accessed 17 Apr 2018)</ref>. It is important to note that morals differ between individuals and cultures, and also that an individual's morals change throughout their life as they mature and their relationships with the environment and people around them change. One model for this is called Kohlberg's Stages of Moral Development<ref>McLeod, S. A. (2013). Kohlberg. Retrieved from www.simplypsychology.org/kohlberg.html </ref>
Morals are defined as standards for what behavior is considered right or wrong.<ref> Oxford Dictionaries,  Oxford University Press, https://en.oxforddictionaries.com/definition/moral (accessed 17 Apr 2018)</ref> It is important to note that morals differ between individuals and cultures, and that an individual's morals change throughout their life as they mature and their relationships with the environment and people around them change. One model for this is called Kohlberg's Stages of Moral Development<ref>McLeod, S. A. (2013). Kohlberg. Retrieved from www.simplypsychology.org/kohlberg.html </ref>


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== What is Moral Agency ==
== What is Moral Agency ==
Moral agency is the capacity to habitually act in an ethical manner. It entails a certain set of competencies in matters ethical as well as moral character and motivation and requires recognition, response, reasoning, discernment, accountability, character, motivation leadership<ref>Fry ST, Veatch RM, Taylor CR. Case studies in nursing ethics. Jones & Bartlett Learning; 2010 Aug 30.</ref>. A moral agent is one who has the authority and responsibility to call the shots<ref>Purtilo, R., Gail M. Jensen, and Charlotte Brasic Royeen. "Educating for moral action: A sourcebook in health and rehabilitation ethics." (2005).</ref>. Moral Agency could be found in individual professionals or collective settings like health care institutions<ref>Jensen GM, Royeen C, Swisher LL, [http://www.cabvibanff.org/uploads/4/6/9/5/4695394/283-swisher-ethics-final.pdf The Critical Role of Professional Identity Formation and Moral Agency], </ref>.
Moral agency is the ability to make ethical decisions based on what is right or wrong. This capacity can be found in individuals or collective entities like businesses or health care institutions.<ref>Jensen GM, Royeen C, Swisher LL, [http://www.cabvibanff.org/uploads/4/6/9/5/4695394/283-swisher-ethics-final.pdf The Critical Role of Professional Identity Formation and Moral Agency], </ref> According to Christen et al.,<ref name=":1">Christen M, Van Schalk C, Fischer J, Huppenbauet M, Tanner C. Empirically informed ethics: Morality between facts and norms. Switzerland: Spinger International Publishing; 2014</ref> moral agency encompasses three major concepts:
# the moral competency of the person or organization in question
# the normative framework on which ethical behavior is based, and
# the situational constraints that influence decision-making.
Moral competencies include reasoning, recognition, response, discernment, accountability, character, motivation, and leadership.<ref>Fry S, Veatch R, and Taylor C. Case Studies in Nursing Ethics, 4<sup>th</sup> edition. Sudbury, MA: Jones & Barlett Learning; 2010</ref> With the appropriate normative framework and a supportive situational environment, moral competency gives rise to sound moral judgements. {{#ev:youtube|dMvGQNPM2z0}}


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== What are Moral Agents ==
A moral agent is any person or collective entity with the capacity to exercise moral agency. Many philosophers posit that rational thought and deliberation are prerequisite skills for any agent.<ref name=":1" /> In this way, moral agents can discern between right and wrong and be held accountable for the consequences of their actions. Likewise, moral agents have the responsibility to anticipate and avoid causing unjust harm.


== What are Moral Agents ==
Children and adults with certain intellectual or psychological disabilities may have little or no ability to function as moral agents.<ref>Mc Combs School of Business, Texas, [http://ethicsunwrapped.utexas.edu/glossary/moral-agent Ethics unwrapped]. </ref> In extreme cases, situational constraints, such as being held hostage, can temporarily prevent adults with full mental capacity from acting as moral agents.
A moral agent is a person who has the ability to discern right from wrong and to be held accountable for his or her own actions. Moral agents have a moral responsibility not to cause unjustified harm. Traditionally, moral agency is assigned only to those who can be held responsible for their actions. Children, and adults with certain mental disabilities, may have little or no capacity to be moral agents. Adults with full mental capacity relinquish their moral agency only in extreme situations, like being held hostage. By expecting people to act as moral agents, we hold people accountable for the harm they cause others<ref>Mc Combs School of Business, Texas, [http://ethicsunwrapped.utexas.edu/glossary/moral-agent Ethics unwrapped]. </ref>.


== Physiotherapist as Moral Agents ==
== Physiotherapist as Moral Agents ==
Students in physiotherapy are generally good people. They enter education programs with an honest desire to help others and as individuals who want to do the "right thing." The general assumption is that the vast majority of students in professional education programs are people who strive to act ethically.
Moral agency is essential to good physical therapy practice. While ethical codes provide a framework for sound behavior, they are not sufficient for navigating the range of moral dilemmas that may come with exercising the profession.<ref name=":0">Triezenberg HL, [https://journals.lww.com/jopte/Abstract/2000/10000/Beyond_the_Code_of_Ethics__Educating_Physical.9.aspx Beyond the Code of Ethics - Educating Physical Therapist for their Role as Moral Agents], Journal of Physical Therapy Education, Winter 2000 </ref>


It could be argued that good moral character and an understanding of the Code of Ethics are all that is needed to ensure good professional behavior. We agree that moral character is a good place to begin and that understanding the Code of Ethics is an important step in professional development. However, we contend that there are additional skills and habits of thought that need to be developed before students are prepared to deal with the moral demands of clinical practice.
Triezenberg et al.<ref name=":0" /> argues that fostering strong moral agents requires preparation from the time students start their physical therapy education. For as much as we may want to do the “right thing”, the judicious application of moral principles in complex scenarios is a skill. Honing this skill requires the development of moral competencies, the integration of said competencies with the values of the profession, and dialogue regarding the ethical dilemmas of practice.<ref name=":0" />


The study of the ethical components of physiotherapy practice and the preparation of for a physiotherapists role as moral agents need to be a central and valued component of physiotherapy education. Moral education for physiotherapist students should include activities that promote:
When physiotherapists understand their role as moral agents, it enhances their ability to identify ethical problems, draw contexually appropriate conclusions, and execute the most sound course of action.<ref name=":2">Edwards I., Delany C.M., Townsend A.F., Swisher L.L., [https://academic.oup.com/ptj/article/91/11/1653/2735120 Moral Agency as Enacted Justice: A Clinical and Ethical Decision-Making Framework for Responding to Health Inequities and Social Injustice], Physical Therapy, Volume 91, Issue 11, 1 November 2011, Pages 1653–1663 </ref><ref name=":3">Raines D. Moral Agency in Nursing. Nurs Forum. 1994; 29(1): 5-11.</ref>
* the development of moral behavior
* the integration into the values and behaviors of the profession, and 
* the ability to engage in dialogue on the ethical components of physiotherapy practice.
Triezenberg et al<ref name=":0" /> suggest these primary goals to be important in the process of preparing physiotherapist students for their role as moral agents.


== Moral Agency in Action ==
== Moral Agency in Action ==
In a hurried practice environment, it is often difficult to identify a specific ethical issue and decide on the best course of action, or to have the time and ability to then act on what you believe to be a good decision. The process of identifying issues, deciding on actions, and having the ability to act requires both knowledge and skills that need to be learned and developed.
The outcome of moral agency is patient-centered care. Within physical therapy practice, therapist-patient encounters act as a forum for understanding patient needs. Personal interaction and mutual learning gives both parties the chance to see the potential to act for positive clinical and ethical change.<ref name=":2" />
 
We use the term "moral" to refer to the personal characteristics and actions of an individual, and we use the term "ethical" to describe a systematic study of behaviors and an evaluation of how the actions of an individual conform to professional standards of conduct<ref name=":0">Triezenberg HL, [https://journals.lww.com/jopte/Abstract/2000/10000/Beyond_the_Code_of_Ethics__Educating_Physical.9.aspx Beyond the Code of Ethics - Educating Physical Therapist for their Role as Moral Agents], Journal of Physical Therapy Education, Winter 2000 </ref>.
 
Moral agency also refers to the realization of a capacity (as an individual or group) to act morally and for change in a situation. If we consider the physiotherapy treatment encounter as a forum or opportunity for acquiring a capacity to act for change (either clinically or ethically), it can be argued that the therapist and patient each bring a particular type of understanding and experience to the encounter. Each expect (or perhaps do not expect) to learn something new from that experience and from the action/interaction that ensues; and each seek some kind of desired and beneficial change from that action/interaction and learning.


Thus, there are 2 different sets of experience—knowledge and learning—that must achieve, first, some kind of translation and, second, some kind of coherence between therapist and patient. The concept of moral agency applies to both therapist and patient, albeit from their different roles and perspectives. The sense of agency experienced by either therapist or patient to act for change in a situation may be influenced, either adversely or for the good, by his or her environmental, social, cultural, work, and socioeconomic contexts<ref>Edwards I., Delany C.M., Townsend A.F., Swisher L.L., [https://academic.oup.com/ptj/article/91/11/1653/2735120 Moral Agency as Enacted Justice: A Clinical and Ethical Decision-Making Framework for Responding to Health Inequities and Social Injustice], Physical Therapy, Volume 91, Issue 11, 1 November 2011, Pages 1653–1663 </ref>.  
Although ideally capacity would be the only factor in PTs exerting moral agency, in practice, contextual variables of the practice environment influence moral conduct.<ref name=":3" /> Time constraints, resources, cultural/social context, competing interests, and organizational policies can all influence the ability of health professionals to be effective moral agents.<ref name=":2" /><ref name=":3" /> When successful, moral agency elevates the integrity of the profession and bolsters the ability of physical therapists to advocate for the best interest of their patients.


The common image of the moral agent is one who makes decisions. Moral decisions are the product of vast calculation. Principles are discerned, judgments are formed, rules of application are weighed. The requirements of duty, the probative force of outcomes and consequences, and the adjudication of competing claims are all fairly transparent to the rational, deliberative agent who engages in extensive cognitive effort in order to resolve dilemmas, make choices, and justify actions. Indeed, the costly investment of cognitive resources into moral deliberation is thought to underlie the very notion of moral autonomy. Moral freedom is grounded in the rational capacity to discern options, make decisions, and enact intentions<ref>Narvaez D., Lapsley D.K., [https://www3.nd.edu/~dnarvaez/documents/NarvaezLapsleyExpertiseProofs.pdf The Psychological Foundations of Everyday Morality and Moral Expertise], 2005, Zugriff 13.4.18</ref>.
== References  ==
== References  ==


<references />
<references />

Revision as of 20:41, 18 April 2018

Original Editor - Andrea Sturm

Top Contributors - Rachael Lowe, Kim Jackson, Tony Lowe, Karen Wilson, Uchechukwu Chukwuemeka, Jess Bell and Robin Tacchetti  

What are Morals[edit | edit source]

Morals are defined as standards for what behavior is considered right or wrong.[1] It is important to note that morals differ between individuals and cultures, and that an individual's morals change throughout their life as they mature and their relationships with the environment and people around them change. One model for this is called Kohlberg's Stages of Moral Development[2]

What is Moral Agency[edit | edit source]

Moral agency is the ability to make ethical decisions based on what is right or wrong. This capacity can be found in individuals or collective entities like businesses or health care institutions.[3] According to Christen et al.,[4] moral agency encompasses three major concepts:

  1. the moral competency of the person or organization in question
  2. the normative framework on which ethical behavior is based, and
  3. the situational constraints that influence decision-making.

Moral competencies include reasoning, recognition, response, discernment, accountability, character, motivation, and leadership.[5] With the appropriate normative framework and a supportive situational environment, moral competency gives rise to sound moral judgements. 

What are Moral Agents[edit | edit source]

A moral agent is any person or collective entity with the capacity to exercise moral agency. Many philosophers posit that rational thought and deliberation are prerequisite skills for any agent.[4] In this way, moral agents can discern between right and wrong and be held accountable for the consequences of their actions. Likewise, moral agents have the responsibility to anticipate and avoid causing unjust harm.

Children and adults with certain intellectual or psychological disabilities may have little or no ability to function as moral agents.[6] In extreme cases, situational constraints, such as being held hostage, can temporarily prevent adults with full mental capacity from acting as moral agents.

Physiotherapist as Moral Agents[edit | edit source]

Moral agency is essential to good physical therapy practice. While ethical codes provide a framework for sound behavior, they are not sufficient for navigating the range of moral dilemmas that may come with exercising the profession.[7]

Triezenberg et al.[7] argues that fostering strong moral agents requires preparation from the time students start their physical therapy education. For as much as we may want to do the “right thing”, the judicious application of moral principles in complex scenarios is a skill. Honing this skill requires the development of moral competencies, the integration of said competencies with the values of the profession, and dialogue regarding the ethical dilemmas of practice.[7]

When physiotherapists understand their role as moral agents, it enhances their ability to identify ethical problems, draw contexually appropriate conclusions, and execute the most sound course of action.[8][9]

Moral Agency in Action[edit | edit source]

The outcome of moral agency is patient-centered care. Within physical therapy practice, therapist-patient encounters act as a forum for understanding patient needs. Personal interaction and mutual learning gives both parties the chance to see the potential to act for positive clinical and ethical change.[8]

Although ideally capacity would be the only factor in PTs exerting moral agency, in practice, contextual variables of the practice environment influence moral conduct.[9] Time constraints, resources, cultural/social context, competing interests, and organizational policies can all influence the ability of health professionals to be effective moral agents.[8][9] When successful, moral agency elevates the integrity of the profession and bolsters the ability of physical therapists to advocate for the best interest of their patients.

References[edit | edit source]

  1. ↑ Oxford Dictionaries, Oxford University Press, https://en.oxforddictionaries.com/definition/moral (accessed 17 Apr 2018)
  2. ↑ McLeod, S. A. (2013). Kohlberg. Retrieved from www.simplypsychology.org/kohlberg.html
  3. ↑ Jensen GM, Royeen C, Swisher LL, The Critical Role of Professional Identity Formation and Moral Agency,
  4. ↑ 4.0 4.1 Christen M, Van Schalk C, Fischer J, Huppenbauet M, Tanner C. Empirically informed ethics: Morality between facts and norms. Switzerland: Spinger International Publishing; 2014
  5. ↑ Fry S, Veatch R, and Taylor C. Case Studies in Nursing Ethics, 4th edition. Sudbury, MA: Jones & Barlett Learning; 2010
  6. ↑ Mc Combs School of Business, Texas, Ethics unwrapped.
  7. ↑ 7.0 7.1 7.2 Triezenberg HL, Beyond the Code of Ethics - Educating Physical Therapist for their Role as Moral Agents, Journal of Physical Therapy Education, Winter 2000
  8. ↑ 8.0 8.1 8.2 Edwards I., Delany C.M., Townsend A.F., Swisher L.L., Moral Agency as Enacted Justice: A Clinical and Ethical Decision-Making Framework for Responding to Health Inequities and Social Injustice, Physical Therapy, Volume 91, Issue 11, 1 November 2011, Pages 1653–1663
  9. ↑ 9.0 9.1 9.2 Raines D. Moral Agency in Nursing. Nurs Forum. 1994; 29(1): 5-11.
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