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Physiotherapy raises serious bioethical questions that are far too little discussed. Concerns include the lack of a clearly defined end point, the closeness of interaction between therapist and patient, the patient’s own share of responsibility, and the common failure to refer patients for rehabilitation.
Physiotherapy has evolved dramatically in recent years, to the point where it is now a major healthcare profession offering assessment, diagnosis and treatment for a wide range of conditions, from sports injuries to rehabilitation for major injuries and diseases. According to the World Confederation for Physical Therapy, “Physical Therapy is providing services to people and populations to develop maintain and restore maximum movement and functional ability throughout the lifespan” (p 28).1
However, almost uniquely among the healthcare professions, physiotherapy has aroused little or no philosophical interest or engagement. This is surprising, because some of the salient features of physiotherapy raise interesting and to some extent novel problems in ethics. There are, it is true, some papers on ethically related themes,2–5 but in comparison with the size of the discipline and the complexity of the problems, the profile of physiotherapy in bioethics is worryingly low.
A first problem is that unlike many areas of medicine—surgery, for example, or radiography or obstetrics and gynaecology—physiotherapy has no obvious end point. In medicine, the end points of treatment are generally well defined, with only a few exceptions, such as plastic surgery or psychiatry. It is my impression that physiotherapy, with few exceptions, does not operate with the concept of end points. (My recent editorial highlights this problem.6) Although what physiotherapy aims at is clear, the point at which the aims are achieved is uncertain. For example, in many cases the patient would go on benefiting from sessions of physiotherapy, perhaps with diminishing returns but still with …
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