Physiotherapy practice - Essay Example

The Legal and Ethical Framework of the Physiotherapeutic Profession: A Contrastive Analysis of German and British Physiotherapy Guidelines and Practices 1 The Physiotherapeutic Profession in the Twenty-First Century 2 Human Rights Laws and Guidelines 3 Physiotherapy in Germany 4 Physiotherapy in the UK 5 Articulation of Existent Differentials from A Lego-Ethical Perspective 7 Conclusion 10 Bibliography 12 The Legal and Ethical Framework of the Physiotherapeutic Profession: A Contrastive Analysis of German and British Physiotherapy Guidelines and Practices While one may not immediately realise this, the fact is that European regionalisation, within the larger context of globalisation, has predetermined the increasing necessity of standardised professional practice. In response to these twin forces, the legal profession, especially the European, is investigating the means by which to standardise the ethical guidelines and best practice framework of the profession, just as industrial and manufacturing organisations and professional bodies are working towards the articulation of a framework for the establishment of minimally acceptable quality standards. The medical profession and the physiotherapeutic one therein, cannot ignore the changing regional and global environment and just as the aforementioned are doing, it too, must respond to the increasing fluidity of national boundaries through the establishment of standardised professional guidelines and best practice models. Currently, and in specific reference to the practice of physiotherapy within the European Union, lack of standardised guidelines for practice is evident. Through a contrastive analysis of the professional guidelines for physiotherapeutic practice in both Germany and the United Kingdom, the ethical and legal differentials shall be highlighted, with the argument centring on the necessity for standardisation as a strategy for the establishment, and subsequent maintenance, of a best practice framework for the profession. In other words, the exigencies of fortifying the lego-ethical base of the physiotherapy profession across the EU, and in immediate compliance with, and acknowledgement of, the operative human rights laws and guidelines, shall be clarified through a discursive analysis of the increasing import of the profession and existent guideline differentials as determined by curricular discrepancies and diverse professional supervisory regulations. The Physiotherapeutic Profession in the Twenty-First Century Advances in diagnostic medicine, concomitant with the noted increase in musculoskeletal problems, have propelled the physiotherapeutic profession to the forefront of drug-free, rehabilitative, curative and pain management therapy (Pinnington, Miller and Stanley, 2004; Grimmer et al., 1999; van den Hombergh et al., 2005). Within the contextual framework of the technological advances witnessed in the latter decades of the twentieth century, inclusive of IT, an ever escalating percentage of the employed populations have had to spend long work hours at their computers, assuming positions which eventually lead to musculoskeletal problems. The most common of these are "cervical and lumbar spine pain, shoulder pain and lower limb trauma," (Clemence and Seamark, 2003: 579), not to mention the increasing prevalence of low back pain (Pinnington, Miller and Stanley, 2004: 372). The aforementioned conditions have, not only emphasised the efficacy of physiotherapy as both a curative and rehabilitative approach but, have enforced renewed respect for this particular health profession upon the medical one, evidenced in escalating GP referral for physiotherapy and, within the framework of the UK National Health Service, reforms designed to facilitate immediate access to such treatment (Clemence and Seamark, 2003: 578-579). Physiotherapy is an integral component of curative and rehabilitative medicine and the work environment of the twenty-first century, insofar as it builds upon and compounds those of the latter decades of the twentieth century, will only enhance the import of the stated profession. It is precisely due to the current, and growing, importance of this profession that its lego-ethical base need be standardised in accordance with the general framework articulated by the European Convention on Human Rights. Human Rights Laws and Guidelines Within the framework of the European Convention on Human Rights, as adopted and implemented by the Council of Europe in 1953, ("Health, HIV and AIDS ," 1998) and as currently operative as a sovereign body of law throughout the EU, the legal and ethical basis of health provision professions is articulated. Article 2 of the European Convention on Human Rights is devoted to an articulation of the right to life, with health issues figuring as an integral componential element of both the right to life and the right to an acceptable quality of life. Within the contextual framework of its legal status as convention signatory and ratifier, the State is the guarantor and protector of the "absolute" right to life with the implication being that it has an inherent duty to ensure, not just public access to health care but, to quality health care, as enhances the quality of life and does not impinge upon it (9-10). Accordingly, it is incumbent upon the State to organise its health care system around that goal, and towards the maintenance of the stated legal responsibility and, as such, ensure that the health care providers within are capable of executing their responsibilities in accordance with the standards established by the concept of best practice. In addition to the above explicated responsibility, and as per Article 8 of the European Convention on Human Rights, the State is legally cautioned against the violation of the concept of "private life" ("Health, HIV and AIDS ," 1998: 11). This means that compulsory medical treatment, unless it is in the greater interest of public health, is both illegal and unethical, whereby human rights laws elucidate the necessity of consent ("Health, HIV and AIDS ," 1998:11-12). Therefore, the State cannot impinge upon an individual's "private life" and violate his/her "physical integrity" through enforced medical treatment/care ("Health, HIV and AIDS ," 1998: 11). Within the parameters of the European Convention on Human Rights, all EU states, including the German and the British, have an inherent responsibility towards the extension of quality health care even though it may not forcibly impose reception of that health care upon individuals. Physiotherapy in Germany If one were to evaluate the legal basis of the physiotherapeutic profession within Germany, on the basis of the legal guidelines established by the European Convention on Human Rights and explicated in the above, one would concede to a high degree of compliance. As highlighted by Eftekari and Bainbridge (2005), the German state has assumed quasi comprehensive responsibility for the psychotherapeutic practice within the state. Governmental policies and regulations articulate the psychotherapeutic educational curriculum, psychotherapy students have to sit for government administered examinations and prior to receiving a license for professional practice, have to have fulfilled all the training and practice criteria established by the German government (5-6). In other words, it is a highly regulated and stringently governed profession. Within the context of the German state, "physiotherapy education and training is at the upper secondary vocational school level," and while the psychotherapy schools, or Schulen fur Physiotherapeuten, are directly affiliated with hospitals, they are not located within a university setting (Eftekari and Bainbridge, 2005: 13). In accordance with government-defined minimal standards, physiotherapy students first receive 2,900 hours of theoretical training at the Schools for Physiotherapy, followed by 1,600 hours of practical training at the hospital or clinic which the school is affiliated with (13 and 16). Following completion of the stated, physiotherapy students are then required to sit for the earlier mentioned exam which, if they successfully complete, are granted a physiotherapy practicing and training license (16-17). As seen from the above, the German state is, in essence, in control of the training, licensing and subsequent regulation of physiotherapists and the physiotherapy profession. While the national laws which have led to this situation are, essentially, in harmony with the European Commission for Human Rights' identification of the state as the protector and guarantor of both the right to life and access to a standard of health care as would fortify the realisation of this right, state domination has prohibited the evolution of autonomous practice (18). In other words, German physiotherapist do not posses the requisite authority to directly treat patients, in the sense that patients must be assigned to them by a medical practitioner, with both the length and type of treatment afforded to patients being decided by the referring medical practitioner. Therefore, physiotherapy is not an autonomous profession, no are German physiotherapists autonomous health care providers as they are required to work under the supervision of a medical profession and according to his orders/recommendations. Physiotherapy in the UK Physiotherapy education ad training in the United Kingdom differs significantly from its German counterpart insofar as it does unfold within a pedagogical setting and is recognised area of specialisation within the larger framework of higher studies. In addition, and instead of being solely governed by the state, culminating in the development f a non-autonomous practice whose practitioners are not qualified to practice in other countries, such as Canada, consequent to curricular differentials, translated as deficiencies by other nations (Eftekari and Bainbridge, 2005: 3), the British physiotherapy profession is both governed by both the state and an independent body. State governance is essentially evidence in the formulation of the general curricular framework and in the articulation of such national laws as governs professional bodies and practitioners within, but the actual management and supervision of the profession is, as is the case with other areas of medical and healthcare practice and provision, the domain of a national non-governmental body ("Practice Note, Sanctions"). Collectively speaking, in the United Kingdom, the totality of medical and health practices, professions and sub-professions within, are governed by the Health Professions Council, established in accordance with the Health Profession Order 2001("Health Care and Associated Professions," 2002: n.p.). As per the dictates of the stated Order, the aforementioned Council is subdivided into four committees, each of whose responsibilities are specifically articulated. One of the committee, for example, assumes responsibility for the supervision of the training and education of health care and medical students; a second committee assumes investigatory responsibilities to ensure the maintenance of best practices; a third undertakes responsibility for ensuring that ethical conduct is maintained by members of the professional and that practicing professionals have the requisite competencies; the fourth committee is the Health Committee ("Health Care and Associated Professions," 2002: n.p.). What needs to be emphasised at this point is that, within the context of these statutory committees, and in accordance with the Health Professions Order 2001, the physiotherapeutic profession is no distinguished from other health and medical provision professions and practitioners are afforded the autonomy denied t their German counterparts. On the basis of the above, one may justifiably observe that the physiotherapy profession in the United Kingdom is founded upon the principle of autonomy. Autonomy here does not simply reference the right of practitioners, or physiotherapists, to offer diagnosis, and suggest and implement treatment, possibly in consultation with the treating physician or general practitioner (van den Hombergh, 2005; Clemence and Seamark, 2003) but, more importantly, highlights the endowment of physiotherapists with the competencies required to do so. In other words, it is necessary to understand and appreciate the fact that academia's embrace of physiotherapy studies as an integral componential element of the larger health and medical profession, has determined that theoretical education and practical training proceed along such lines as would endow professionals with the requisite medical knowledge and diagnostic competencies to function autonomously. Articulation of Existent Differentials from A Lego-Ethical Perspective As per the above, one may affirm that the primary differential between physiotherapy training and practice in the United Kingdom as compared to the Republic of Germany, is that the first is founded upon the principle of autonomous practice while the second is not. Apart from the preceding observations regarding the extent to which the British physiotherapy educational and training curriculum allows for this, as do national healthcare and medical provision laws, while the German counterparts do not, the fact is that this disparity has important ethical and legal underpinnings. As pertains to the ethical issues inherent in the stated differential, one might reference a study by Geddes, Wessel and Williams (2004), entitled "Ethical issues identified by physical therapy students during clinical placements." This study, based on the observation and survey of 56 UK third year physical therapy students, articulates the ethical issues and challenges which physiotherapists confront, as perceived by the surveyed group (17). The leading ethics issues and dilemmas, as identified by this study, pertain to the concept of autonomy, insofar as the British physical therapy students voiced concern over their abilities to diagnose spinal and muscular ailments, devise a course for therapeutic treatment and ensure that available resources are stretched to accommodate a patient's needs (17-20). In other words, ethical concerns revolved around the professional responsibility that is inextricably linked to the concept of autonomous practice. Insofar as German physiotherapy students and practitioners are concerned one might assume that these particular concerns would not be voiced insofar as the physical therapist is only responsible for the execution of the medical doctor's treatment guidelines to the best of his/her professional ability. The physical therapist, here, is not responsible for either diagnosis of ailment and articulation of treatment methodology and duration and, thus, will not have the same ethical responsibilities or concerns as would a British physical therapist. In light of the above, and more specifically as relates to the autonomous nature of the British physiotherapy practice versus the non-autonomous nature of the German practice, one make forward he assumption that the British practitioner is infinitely more concerned with, and liable for, malpractice. Dronberger (2003) observes that a perennial and predominant concern among autonomous medical and healthcare professionals is the accusation of neglect, possibly culminating in a malpractice lawsuit. Physical therapists are just as concerned with this particular legal problem as are any other medical professionals and, possibly, even more so, since they are expected to produce results within a limited and predefined time period (151-152). In other words, and in immediate contrast to other health care professionals, patients expect that the outlined physical therapy program, produce results within the parameters of the duration. If not, the physical therapist is vulnerable to allegations concerning inefficient exercise of professional duties and ineffective delivery of a healthcare service. Insofar as the autonomous nature of the British physiotherapy profession solidifies both the legal and ethical responsibilities of individual practitioners, they are definitely more vulnerable than their German counterparts. Precisely due to the stated difference and the greater professional responsibility carried by the British, as compared to the German, physiotherapy professional, Edwards et al. (2004) contend that the value of collaborative reasoning is better appreciated by autonomous, as opposed to non-autonomous practitioners (70-71). The concept of collaborative reasoning is intimately founded upon the fact that, within the framework of physiotherapeutic treatment, the active participation of the patient is a prerequisite for successful outcome, with the underlying logic here being that collaboration between patient and physiotherapist is a predicator of successful treatment (70-71). Accordingly, given their autonomous status, implying that they cannot rescind their immediate responsibility towards a patient and regard themselves as instruments for the execution of a medical doctor's prescription, British physiotherapists, as compared to their German counterparts, will exert greater effort in attaining patient participation, collaboration and cooperation. In addition to the above, Elkin (2001) observes that autonomous practitioners are infinitely more likely to assume direct responsibility for attaining informed consent than non-autonomous practitioners would be (97-98). As earlier stated, the inviolability of "private life" has predetermined the illegality of enforcing medical treatment or care upon a patient, with the implication being that explicit consent has to be requested and received prior to the implementation of a treatment programme. Insofar as the British physiotherapist is concerned, and as emphasised by Elkin (2001) it is incumbent upon him/her to obtain the patient's informed consent to the treatment programme. The German physiotherapist, in comparison, does not have the same responsibility insofar as he is not an autonomous practitioner, with the implication being hat the obtaining of informed consent is the treating medical practitioner's legal responsibility, not that of the physiotherapist. As may be inferred from the above, autonomy versus non-autonomy, function as the basis for differing lego-ethical concerns. Needless to say, the legal and ethical responsibilities of efficient practice weigh greater upon the British physiotherapist than they o upon the German but, the British physiotherapist is academically qualified to tackle that greater responsibility. Conclusion Within the boundaries of the European Union, and as explicated through the above analysis of existing guideline differentials between the United Kingdom and Germany, there are no standardised legal principles for the physiotherapeutic profession, with the implication being that there is similar legal disparity. In light of inter-EU border fluidity, or borderless-ness, imperatives of standardising the practice can hardly be overemphasised. As suggested in the above, the optimal strategy for attainment of standardisation is through curricular reforms which aim towards pedagogical regionalisation, with focus upon the production of autonomous practitioners. Thus, not only is there a need for standardisation but there is a specific need for the fortification of physiotherapy as an autonomous practice insofar as autonomy facilitates access and allows a qualified specialist to determine, not only whether physiotherapy is required or not, but the methodology and length of the treatment, ultimately contributing towards the maximisation of delivery efficiency and effectiveness. Bibliography Clemence, M.L. and D.A. Seamark 2003. "GP referrals for physiotherapy to musculoskeletal conditions - a quantitative study.' Family Practice. [Online] Vol. 20, No. 5: 578-582. Available from: Oxford journals Online. [20 December 2005]. Dronberger, Jim 2003. Fraud and negligence in physical therapy practice: A case example.' Physiotherapy Theory and Practice. [Online]. Vol. 19: 151-159. Available from: EBSCOhost. [20 December 2005]. Edwards, Ian et al. 2004. What is collaborative reasoning' Advances in Physiotherapy. [Online]. Vol. 6: 70-83. Available from: EBSCOhost. [20 December 2005]. Elkin, Sandy 2001. Informed consent: Requirements for legal and ethical practice.' Physiotherapy Theory and Practice. [Online]. Vol. 17: 97-105. Available from: EBSCOhost. [20 December 2005]. Geddes, E.L, J. Wessel, and R.M. Williams 2004. Ethical issues identified by physical therapy students during clinical placements.' Physiotherapy Theory and Practice. [Online]. Vol. 20: 17-29. Available from: EBSCOhost. [20 December 2005]. Grimmer, K. et al. 1999. Differences in stakeholder expectations in the outcome of physiotherapy management of acute low back pain.' International Journal for Quality in Health Care. [Online] Vol. 11, No. 2: 155-162. Available from: Oxford journals Online. [20 December 2005]. Pinnington, M.A., J. Miller and I. Stanley 2004. An evaluation of prompt access to physiotherapy in the management of low back pin in primary care.' Family Practice. [Online] Vol. 21, No. 4: 372-380. Available from: Oxford journals Online. [20 December 2005]. Van den Hombergh, P. et al. 2005. Saying goodbye to single-handed practices: What do patients and staff lose or gain' Family Practice. [Online] Vol. 22: 20-27. Available from: Oxford journals Online. [20 December 2005]. Read More