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<p>Although ethical decision-making in rehabilitation is increasingly complex, physical therapy remains marginal in mainstream philosophical bioethics. This paper critically interrogates the normative limitations of principlism, particularly the framework articulated by Beauchamp and Childress, in addressing moral dilemmas within physical therapy practice, especially in contexts characterized by systemic inequities, cultural plurality, and hierarchical institutional structures. Drawing upon my clinical experience as a licensed physical therapist in both the Philippines and the United States, I analyze ethically charged scenarios involving premature discharge, coerced consent, and institutional practices that undermine therapeutic justice. While principlism offers a widely accepted ethical schema, its abstraction and proceduralism often render it inadequate in morally ambiguous and relationally complex clinical situations. To respond to these limitations, I propose a more context-sensitive and philosophically robust framework by integrating Hare’s two-level utilitarianism, Habermas’s discourse ethics, feminist care ethics, and Kohlberg’s theory of moral development. These perspectives collectively reconceptualize ethical reasoning as dialogical, developmental, and attentive to the affective and political dimensions of care. Through philosophical analysis, narrative reflection, and engagement with lived clinical experience, I argue that physical therapists must be recognized not merely as technical practitioners, but as moral agents engaged in situated ethical judgment. This paper contributes to the evolving discourse on bioethics in allied health professions by foregrounding moral ingenuity, structural critique, and relational accountability as essential to ethical excellence in rehabilitative practice.</p>

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Care, Consent, and Compromise: An Ethical Cartography of Physical Therapy Practice in the Global South

  • 期刊论文

  • 发表日期：

    2026年4月24日

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  • Mark Loubert A. Hernandez

摘要

Although ethical decision-making in rehabilitation is increasingly complex, physical therapy remains marginal in mainstream philosophical bioethics. This paper critically interrogates the normative limitations of principlism, particularly the framework articulated by Beauchamp and Childress, in addressing moral dilemmas within physical therapy practice, especially in contexts characterized by systemic inequities, cultural plurality, and hierarchical institutional structures. Drawing upon my clinical experience as a licensed physical therapist in both the Philippines and the United States, I analyze ethically charged scenarios involving premature discharge, coerced consent, and institutional practices that undermine therapeutic justice. While principlism offers a widely accepted ethical schema, its abstraction and proceduralism often render it inadequate in morally ambiguous and relationally complex clinical situations. To respond to these limitations, I propose a more context-sensitive and philosophically robust framework by integrating Hare’s two-level utilitarianism, Habermas’s discourse ethics, feminist care ethics, and Kohlberg’s theory of moral development. These perspectives collectively reconceptualize ethical reasoning as dialogical, developmental, and attentive to the affective and political dimensions of care. Through philosophical analysis, narrative reflection, and engagement with lived clinical experience, I argue that physical therapists must be recognized not merely as technical practitioners, but as moral agents engaged in situated ethical judgment. This paper contributes to the evolving discourse on bioethics in allied health professions by foregrounding moral ingenuity, structural critique, and relational accountability as essential to ethical excellence in rehabilitative practice.