Moral conflicts in physiotherapy practice: perception of physiotherapists and students
10.15343/0104-7809.202145551563
Keywords:
Bioethics. Professional ethics. Deliberation. Higher education. Physiotherapy.Abstract
Moral conflicts are inherent to the practice of physiotherapy, more so as manifestations of the scientific evolution are increasingly more present in the professional praxis of the physiotherapist, which demands a close contact between the professional and the patient. The objective of this study was to analyze the perception of physiotherapists and students in a physiotherapy program towards moral conflicts in clinical practice. A cross-sectional study was performed by means of a questionnaire applied to students in initial (Group 1) and final (Group 2) stages of a physiotherapy course as well as to physiotherapists (Group 3) working in cities in the Midwest of Santa Catarina, Brazil. The sample consisted of 110 students, 59 in Group 1 and 51 in Group 2, with a mean age of 22.7 years old and were predominantly females. Moreover, there were 36 physiotherapists included in Group 3, most of whom were female, with ages ranging from 31 to 40 years old and with 11 to 20 years of training. Almost all students and professionals reported that approaching professional ethics and bioethics in professional training is particularly important. The students in the more advanced stages, who had taken the bioethics course, showed greater general knowledge when compared to the other groups, indicating the importance of teaching this theme at the undergraduate level. Most professionals (75%) self-reported little knowledge on the topics discussed in the Ethics and Deontology Code of Physiotherapy; 72% affirmed having partially read the document, but only 47% get annual updates on the ethics code. The conflicts most frequently mentioned by the professionals were secrecy and confidentiality (61.1%), intra- and interprofessional relationship (33.3%), fees (30.5%), professional autonomy (25%), truthfulness of information (19.4%), therapist/patient relationship (16.7%), and patient autonomy, decency, and intimacy (5.5%). Moral conflicts are part of the practice of physiotherapy, even if it was not sufficiently acknowledged by the participants in some cases. Based on this study, some measures are needed regarding teaching, professional recycling, and the inclusion of themes in the professional code of physiotherapy, considering that some issues constitute a challenge for ethical training. Unfortunately, but they are not addressed in the physiotherapist’s professional code of ethics and professionals who finished training before did not have adequate learning on the topics discussed.
Downloads
References
2. Badaró AFV, Guilhem D. Bioética e pesquisa na fisioterapia: aproximação e vínculos. Fisioter Pesqui. 15(4);402-407. DOI: 10.1590/ S1809-29502008000400015.
3. Paiva LM. A inserção das disciplinas de ética, deontologia e bioética nos cursos de graduação em fisioterapia em universidades e centros universitários no Brasil. Brasília: Universidade de Brasília, 2015. Tese de Doutorado em Ciências da Saúde. 131p. Disponível em: https://repositorio.unb.br/bitstream/10482/19608/1/2015_LeticiaMartinsPaiva.pdf
4. Brasil. Conselho Nacional de Educação. Câmara de Educação Superior. Resolução n. CNE/CES, 19 fev. 2002. Diretrizes Curriculares Nacionais do Curso de Graduação em Fisioterapia. Diário Oficial da União Brasília, DF, n. 42, seção 14. Mar. 2002.
5. Carvalho JBS, Moreira Filho RE. Biodireito e bioética: percepções entre fisioterapeutas e estudantes de fisioterapia. Fisioter. Saúde Func. 2014;3(1):18-22.
6. Conselho Federal de Fisioterapia e Terapia Ocupacional – COFFITO. Resolução n. 424. Estabelece o Código de Ética e Deontologia da Fisioterapia. Diário Oficial da União. Brasília, DF, Seção I, Parte I. 1 ago. 2013.
7. Renner AF, Goldim JR, Prati FM. Dilemas éticos presentes na prática do fisioterapeuta. Braz J Phys Ther. 2017;6(3):135 -138.
8. Lorenzo CFG, Bueno GTA. A interface entre bioética e fisioterapia nos artigos brasileiros indexados. Fisioter. Mov. 2013;26(4)763- 775. DOI: 10.1590/S0103-51502013000400006.
9. Ladeira TL, Silva Junior AG, Koifman L. Fundamentos éticos en la toma de decisión de discentes de fisioterapia. Interface. 2017;21(62):675-685. DOI: 10.1590/1807-57622016.0273.
10. Bettini-Pereira RA, Blascovi-Assis SM. Formação em Fisioterapia: Reflexões sobre a identificação de dilemas éticos na prática clínica. São Paulo: Universidade Presbiteriana Mackenzie, 2008. Dissertação de Mestrado.
11. Badaró AFV. Ética e bioética na práxis da fisioterapia: desvelando comportamentos. 2008. 164 p. Universidade de Brasília, Brasília, 2008. Tese de doutorado em Ciências da Saúde. Disponível em: https://repositorio.unb.br/bitstream/10482/1378/1/2008_ AnaFatimaVieroBadaro.pdf
12. Vieira PSPG, Neves NMBC. Ética médica e bioética no curso médico sob o olhar dos docentes e discentes. Mundo Saúde. 2009;33(1):21-25. DOI: 10.15343/0104-7809.200933.1.2.
13. Alves FD, Bigongiari A, Mochizuki L, Hossne WS, Al,meida M. O preparo bioético na graduação de Fisioterapia Fisioter Pesqui. 2008;15(2):149-156. DOI: 10.1590/S1809-29502008000200007.
14. UNESCO. Declaração Universal de Bioética e Direitos Humanos. Adotada por aclamação em 19 de outubro de 2005 pela 33ª. Sessão da Conferência Geral da UNESCO. Paris. Out 2005.
15. Sánchez-Alfaro’s LAB. Notions about Social Justice Built by Physical Therapy tudents of the Corporación Universitaria Iberoamericana. Aleth Rev. 2020;12(1):117-136.
16. Villalobos Teanga CS. Conocimiento y aplicación de los principios bioéticos en los fisioterapeutas de la provincia de Imbabura. Universidad Técnica del Norte, Ibarra, Equador, 2018. Tese de Licenciatura em Terapia Física Médica. 55p. Disponível em: http:// repositorio.utn.edu.ec/handle/123456789/8640
17. Magalhães AB, Pereira MNS, Nascimento BNP, Lima MDS, Gimenes RO, Teixeira RC. Perception, interest and knowledge of physiotherapy faculty regarding professional ethics. Rev Bioét. 2016;24(2):322-331. DOI: 10.1590/1983-80422016242133.
18. Almeida ALJ, Guimarães RB. O lugar social do fisioterapeuta brasileiro. Fisioter. Pesqui. 2009;16(1);82-8. DOI: 10.1590/S1809- 29502009000100015.
19. Barnitt R. Ethical dilemmas in occupational therapy and physical therapy: a survey of practitioners in the UK National Health Service. J. Med. Ethics. 1998;24(3):193-199. DOI: 10.1136/jme.24.3.193.
20. Swisher LL. A retrospective analysis of ethics knowledge in physical therapy (1970-2000). Phys Ther. 2002;82(7):692-706. DOI: 10.1093/ptj/82.7.692.
21. Moscoso Herrera J. Los dilemas del fisioterapeuta en el área asistencial: una mirada a la toma de decisiones. Movimiento Científico. 2011;5(1):6-4. DOI: 10.33881/2011-7191.%25x.
22. Scheirton LS, Mu K, Lohman H, Cochran TM. Error and patient safety: ethical analysis of cases in occupational and physical therapy practice. Med Health Care Philos. 2007;10(3):301‐311. DOI: 10.1007/s11019-007-9049-3.
23. Freiberger MH, Bonamigo EL. Attitude of cancer patients regarding the disclosure of their diagnosis. Mundo Saude. 2018;42(2):393- 414. DOI: 10.15343/0104-7809.20184202393414.
24. Araújo L, Neves Júnior WA. The bioethics and the physiotherapy in the Intensive Therapy Units. Fisioter Pesqui. 2003;10(2):52-0. DOI: 10.1590/fpusp.v10i2.78115.
25. Comin LT, Panka M, Beltrame V, Steffani JA, Bonamigo EL. Perception of oncology patients on the terminality of life. Rev Bioét. 2017;25(2):392-401. DOI: 10.1590/1983-80422017252199.
26. Voors M. The Duty to Treat: Ethics and HIV/AIDS. Physiotherapy. 2000;86(12):640-644. DOI: 10.1016/S0031-9406(05)61301-6.
27. Sim J. Confidentiality and HIV status. Physiotherapy. 1997;83(2):90-96. DOI: 10.1016/S0031-9406(05)65585-X.
28. Conselho Federal de Medicina. Parecer CFM n. 11 de 1992. AIDS e Ética Médica. Brasília, DF, 1992.
29. Engels EA, Pfeiffer RM, Goedert JJ, Virgo P, McNeel TS, Scoppa SM, Biggar RJ. Trends in cancer risk among people with AIDS in the United States 1980-2002. AIDS. 2006;20(12):1645‐1654. DOI: 10.1097/01.aids.0000238411.75324.59
30. Heller P, Baptistella AR, Bonamigo ELB. Moral Conflicts in The Physiotherapy Praxis Teaching: Patients’ Perception and Attitude. Cad. Edu Saúde e Fis. 2020;7(13):e071406. DOI: 10.18310/2358-8306.v7n14.a6
31. Costa BP, Duarte LA. Reflexões bioéticas sobre finitude da vida, cuidados paliativos e fisioterapia. Rev Bioet. 2019;27(3):510-5. DOI: 10.1590/1983-80422019273335
