The Role of Emotions in Ethical Decision Making: Implications for Physical Therapist Education

Abstract

Background and Purpose. Competence and commitment to ethical practice is fundamental to the professional development of physical therapist students. Recent research in neuroethics and ethical decision making has illustrated the importance of emotions in moral behavior and ethical decision making. The purpose of this paper is to highlight and explore the importance of emotions in making ethical decisions and to advocate for a role of emotional considerations in physical therapist education program curricula. Position and Rationale. Increased education in the role of emotions in moral behavior and ethical decision making should be a priority for physical therapists and students enrolled in physical therapist professional education programs. The rationale for this position is based on contemporary theories of bioethics and recent research in neuroethics that has uncovered the nexus between emotions and reason that results in caring and empathetic ethical decision making. This position is consistent with A Normative Model of Physical Therapist Professional Education. That document lists caring and compassion as primary values for professional development of physical therapists. Recommendations. Faculty involved in professional physical therapist education need to consider what implications including emotions in ethical decision making could have for physical therapist practice and education. This paper provides some strategies of learning experiences that facilitate emotional reflection in ethical decision making and that may be integrated into a preexisting curriculum. Key Words: Ethics, Morality, Emotions, Feelings, Reason. BACKGROUND AND PURPOSE The following article is based on the position that morality and ethics are rooted deeply in the Western philosophic tradition that elevates rational decision making above emotions. With few exceptions, emotions have been continually allocated secondary status in Western tradition that historically was a rationalist tradition - an approach founded on the fundamental dichotomy between the rational and irrational, between the emotional and physical.1-4 Kant,5 for example, argued that absolute universally moral principles can be derived from the essence of pure practical reason, and that passion is reason's antagonist and it struggles with reason over the control of the will. His writing helped formed the basis of the ethical theory of deontology, or duty-based ethics, that in turn forms the basis of most health care ethical codes, including the American Physical Therapy Association Code of Ethics.6 Deontology theory holds that an individual is acting rightly when he or she is acting according to duties and rights. To many health care professionals who embrace the centrality of rationality in decision making, the acknowledgement of emotions and feelings signify unprofessional behavior and, at times, weakness.7 Callahan,8 however, reminds us that, as we think through moral options and pursue sound logical arguments, negative and positive emotions and feelings can arise that influence our moral behavior. Zhong9 concurs, and argues that rational, ethical decision making may actually license unethical behavior when it minimizes certain negative and positive emotions such as guilt, contempt, disgust, gratitude, awe, or elevation. In recent years there has been increasing recognition of the importance of emotions related to empathy, virtue ethics, ethics of caring, and self-reflection in ethics education.1011 Contemporary educators criticize a rational and technical approach that overemphasizes logical thinking as lacking imagination and feelings.13,13-18 But despite such criticism, many models, training curricula, texts, and empirical and theoretical literature that consider components of moral behavior-including ethical decision making-continue to emphasize disproportionately a rational approach to solving moral issues and dilemmas. The premises of this paper are that Western ethical tradition emphasizes reason at the expense of emotion and that physical therapy has followed a rational model of ethical decision making using a linear principlebased approach. …