"ethic of care" in physical therapy practice and education: Challenges and opportunities, The

Journal of Physical Therapy Education, Winter 2000 by Romanello, Mary

The patient, as the cared-for, accepts the physical therapist's guidance and assistance in developing, executing, and revising the treatment plan. In recognition of the therapist's attitude toward him or her, the patient allows the physical therapist to intervene in his or her medical care with the intent to help improve the patient's physical function. In accepting treatment, the patient reciprocates the caring action by responding to the therapist's attention and engrossment. The caring relationship is thus completed through the apprehension of caring by the cared-for, the patient. Caring is, in sum, a relational encounter involving the one-caring's receptivity of the cared-for and the cared-foes reciprocity to the one-caring (Figure). In a caring relationship between physical therapist and patient, the physical therapist demonstrates an attitude that reflects a sensitivity to "the patient's deepest values and concerns and constructively addresses them." 15(p2100)

Clinical and Educational Issues Involved in an Ethic of Care

Constructing More Equitable Relationships: Patient as Subject, Not Object

The burden is on the therapist to construct the professional-patient relationship on equitable terms. Lebacqz12(p114) noted that the role of the professional is one of authoritative power, which is given to the professional by society. She stated that professionals have power in that they do not simply fix a patient's problem, but define the problem as well. 12(p 119) Brody20(pp 1617) discussed the three types of power that physicians and other heaters have in our society: the power of knowledge/training, the power of charisma and personal characteristics that appeal to patients, and the power of social status held by members of the medical profession in our society. Physical therapists wield much authority in working with patients, and this power imbalance between patient and therapist can impede the development of a caring relationship. Pelligrino21 contended that the inequality between the health care professional and the patient must be removed as fully as possible before the humanity of the patient is restored. It is the responsibility of the therapist to diffuse a paternalistic relationship if a caring relationship is to develop. Lebacqz12 stated that "the first priority of a professional ethic must be the restoration of autonomy of the client and liberation of the client from unequal power."12(p 117)

By focusing on patient-centered practice where the patients goals and desired outcome for treatment are central to developing the treatment plan,22 the therapist enhances a more equitable therapist-patient relationship. A therapist-client relationship that gives the patient a voice by listening to the patient and understanding how he or she thinks empowers the patient to fully participant in the rehabilitation process. Such a relationship engages the therapist and the patient to recognize their own as well as the others' strengths and weaknesses and how each influences the course of treatment. The physical therapist and the patient need to be partners in developing a caring relationship, using each therapist-patient encounter to determine what is of greatest importance to meet the patients goals of treatment. At times physical therapy sessions may address the patients physical needs, whereas at other times the impact of family and societal influences may require attention before further physical progress can be realized. In a caring relationship, responsibility lies with both the patient and the physical therapist. The degree of responsibility possessed by each individual in the relationship is determined by each situational encounter during the course of treatment.