Moral Agency

Original Editor - Andrea Sturm

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

What are Morals

Morals are defined as standards for what behaviour is considered right or wrong. It is important to note that morals differ between individuals and cultures, and that an individual's morals change throughout their life as they mature and their relationships with the environment and people around them change. One model for this is called Kohlberg's Stages of Moral Development

What is Moral Agency

Moral agency is the ability to make ethical decisions based on what is right or wrong and to be held accountable for these actions. This capacity can be found in individuals or collective entities like businesses or health care institutions. According to Christen et al., moral agency encompasses three major concepts:

1. the moral competency of the person or organisation in question
2. the normative framework on which ethical behaviour is based, and
3. the situational constraints that influence decision-making.

Moral competencies include reasoning, recognition, response, discernment, accountability, character, motivation, and leadership. With the appropriate normative framework and a supportive situational environment, moral competency gives rise to sound moral judgements. 

What are Moral Agents

A moral agent is any person or collective entity with the capacity to exercise moral agency. Many philosophers posit that rational thought and deliberation are prerequisite skills for any agent. In this way, moral agents can discern between right and wrong and be held accountable for the consequences of their actions. Likewise, moral agents have the responsibility to anticipate and avoid causing unjust harm.

Children and adults with certain intellectual or psychological disabilities may have little or no ability to function as moral agents. In extreme cases, situational constraints, such as being held hostage, can temporarily prevent adults with full mental capacity from acting as moral agents.

Physiotherapist as Moral Agents

Moral agency is essential to good physical therapy practice. While ethical codes provide a framework for sound behavior, they are not sufficient for navigating the range of moral dilemmas that may come with exercising the profession.

Triezenberg et al. argues that fostering strong moral agents requires preparation from the time students start their physical therapy education. For as much as we may want to do the “right thing”, the judicious application of moral principles in complex scenarios is a skill. Honing this skill requires the development of moral competencies, the integration of said competencies with the values of the profession, and dialogue regarding the ethical dilemmas of practice.

When physiotherapists understand their role as moral agents, it enhances their ability to identify ethical problems, draw contextually appropriate conclusions, and execute the most sound course of action.

Moral Agency in Action

The outcome of moral agency is patient-centered care. Within physical therapy practice, therapist-patient encounters act as a forum for understanding patient needs. Personal interaction and mutual learning gives both parties the chance to see the potential to act for positive clinical and ethical change.

Although ideally capacity would be the only factor in PTs exerting moral agency, in practice, contextual variables of the practice environment influence moral conduct. Time constraints, resources, cultural/social context, competing interests, and organisational policies can all influence the ability of health professionals to be effective moral agents. When successful, moral agency elevates the integrity of the profession and bolsters the ability of physical therapists to advocate for the best interest of their patients.