Moral Agency

Original Editor - Andrea Sturm

Top Contributors - Rachael Lowe, Kim Jackson, Tony Lowe, Karen Wilson, Uchechukwu Chukwuemeka, Jess Bell and Robin Tacchetti  

What is Moral Agency

Moral agency is the capacity to habitually act in an ethical manner. It entails a certain set of competencies in matters ethical as well as moral character and motivation and requires recognition, response, reasoning, discernment, accountability, character, motivation leadership (Fry, Veatch, and Taylor, 2006). A moral agent is one who has the authority and responsibility to call the shots (Purtilo, p 7 in Educating for Moral Action). Moral Agency could be found in individual professionals or collective settings like health care institutions.

What are Moral Agents

A moral agent is a person who has the ability to discern right from wrong and to be held accountable for his or her own actions. Moral agents have a moral responsibility not to cause unjustified harm. Traditionally, moral agency is assigned only to those who can be held responsible for their actions. Children, and adults with certain mental disabilities, may have little or no capacity to be moral agents. Adults with full mental capacity relinquish their moral agency only in extreme situations, like being held hostage. By expecting people to act as moral agents, we hold people accountable for the harm they cause others.

Physiotherapist as Moral Agents

Students in physiotherapy are generally good people. They enter education programs with an honest desire to help others and as individuals who want to do the "right thing." The general assumption is that the vast majority of students in professional education programs are people who strive to act ethically.

It could be argued that good moral character and an understanding of the Code of Ethics are all that is needed to ensure good professional behavior. We agree that moral character is a good place to begin and that understanding the Code of Ethics is an important step in professional development. However, we contend that there are additional skills and habits of thought that need to be developed before students are prepared to deal with the moral demands of clinical practice.

The study of the ethical components of physiotherapy practice and the preparation of for a physiotherapists role as moral agents need to be a central and valued component of physiotherapy education. Moral education for physiotherapist students should include activities that promote:

• the development of moral behavior
• the integration into the values and behaviors of the profession, and
• the ability to engage in dialogue on the ethical components of physiotherapy practice.

These primary goals we believe to be important in the process of preparing physiotherapist students for their role as moral agents.

In a hurried practice environment, it is often difficult to identify a specific ethical issue and decide on the best course of action, or to have the time and ability to then act on what you believe to be a good decision. The process of identifying issues, deciding on actions, and having the ability to act requires both knowledge and skills that need to be learned and developed.

We use the term "moral" to refer to the personal characteristics and actions of an individual, and we use the term "ethical" to describe a systematic study of behaviors and an evaluation of how the actions of an individual conform to professional standards of conduct.

Moral agency also refers to the realization of a capacity (as an individual or group) to act morally and for change in a situation. If we consider the physiotherapy treatment encounter as a forum or opportunity for acquiring a capacity to act for change (either clinically or ethically), it can be argued that the therapist and patient each bring a particular type of understanding and experience to the encounter. Each expect (or perhaps do not expect) to learn something new from that experience and from the action/interaction that ensues; and each seek some kind of desired and beneficial change from that action/interaction and learning.

Thus, there are 2 different sets of experience—knowledge and learning—that must achieve, first, some kind of translation and, second, some kind of coherence between therapist and patient. The concept of moral agency applies to both therapist and patient, albeit from their different roles and perspectives. The sense of agency experienced by either therapist or patient to act for change in a situation may be influenced, either adversely or for the good, by his or her environmental, social, cultural, work, and socioeconomic contexts.

The common image of the moral agent is one who makes decisions. Moral decisions are the product of vast calculation. Principles are discerned, judgments are formed, rules of application are weighed. The requirements of duty, the probative force of outcomes and consequences, and the adjudication of competing claims are all fairly transparent to the rational, deliberative agent who engages in extensive cognitive effort in order to resolve dilemmas, make choices, and justify actions. Indeed, the costly investment of cognitive resources into moral deliberation is thought to underlie the very notion of moral autonomy. Moral freedom is grounded in the rational capacity to discern options, make decisions, and enact intentions.