Moral Agency

What are Morals[edit | edit source]

Morals are defined as standards for what behaviour is considered right or wrong.[1] 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[2]. The most referenced model for this change is Kohlberg's Stages of Moral Development[3][4][5]:

Others have elaborated on the characteristics of the stages of moral development with special reference to psychological needs, altruism and human relationships, and justice reasoning[6]:

What is Moral Agency[edit | edit source]

Moral agency is the ability to make ethical decisions based on what is right or wrong. This capacity can be found in individuals or collective entities like businesses or health care institutions.[7] According to Christen et al.,[8] 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 competence refers to the capacity of an individual to "make decisions and judgments, which are moral based on internal principles and to act according to them."[9] Moral competencies include reasoning, recognition, response, discernment, accountability, character, motivation, and leadership.[10] With the appropriate normative framework and a supportive situational environment, moral competency gives rise to sound moral judgements. 

In contrast to this, moral distress is said to occur when an individual makes a moral judgement, but is unable to act upon it.[11][12] Moral distress can result in emotional distress, frustration and anger.[13] 

What are Moral Agents[edit | edit source]

A moral agent is any person or collective entity with the capacity to exercise moral agency. It is suggested that rational thought and deliberation are prerequisite skills for any agent.[8] 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.[14] 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[edit | edit source]

Moral agency is essential to good physical therapy practice. While ethical codes provide a framework for sound behaviour, they are not sufficient alone for navigating the range of moral dilemmas that may come with practicing the profession.[15]

Triezenberg et al.[15] argues that fostering strong moral agents requires preparation from the time students start their physiotherapy 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 these competencies with the values of the profession, and dialogue regarding the ethical dilemmas of practice.[15]

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.[16][17]

Moral Agency in Action[edit | edit source]

The outcome of moral agency is patient-centred care. Within physiotherapy practice, the therapist-patient interaction acts as a forum for understanding specific patient needs. Personal interaction and mutual learning gives both parties the chance to see the potential to act for positive clinical and ethical change.[16]

Although ideally capacity would be the only factor in physiotherapists exerting moral agency, in practice, contextual variables of the practice environment influence moral conduct.[17] Time constraints, resources, cultural/social context, competing interests, and organisational policies can all influence the ability of health professionals to be effective moral agents.[16][17] When successful, moral agency elevates the integrity of the profession and bolsters the ability of physiotherapists to advocate for the best interest of their patients.

References[edit | edit source]

  1. Oxford Dictionaries, Oxford University Press, (accessed 17 Apr 2018)
  2. Narvaez D, Lapsley DK. The psychological foundations of everyday morality and moral expertise. Character psychology and character education. 2005; 28:140-65.
  3. Kohlberg, L. The Development of Modes of Thinking and Choices in Years 10 to 16. Chicago:University of Chicago. 1958
  4. Kohlberg, L.The Psychology of Moral Development: The Nature and Validity of Moral Stages (Essays on Moral Development). volume 2. Harper & Row, 1984.
  5. Mathes, Eugene. An evolutionary perspective on Kohlberg’s theory of moral development. Current Psychology. 2019:1-14.
  6. Ma HK. The moral development of the child: an integrated model. Frontiers in public health. 2013; 18(1):
  7. Jensen GM, Royeen C, Swisher LL, The Critical Role of Professional Identity Formation and Moral Agency,
  8. 8.0 8.1 Christen M, Van Schalk C, Fischer J, Huppenbauet M, Tanner C. Empirically informed ethics: Morality between facts and norms. Switzerland: Spinger International Publishing; 2014
  9. Haghighat S, Borhani F, Ranjbar H. Is there a relationship between moral competencies and the formation of professional identity among nursing students? BMC Nurs. 2020;19:49.
  10. Fry S, Veatch R, Taylor C. Case Studies in Nursing Ethics. 4th edition. Sudbury, MA: Jones & Barlett Learning; 2010
  11. Morley G, Ives J, Bradbury-Jones C, Irvine F. What is 'moral distress'? A narrative synthesis of the literature. Nurs Ethics. 2019;26(3):646-62.
  12. McAndrew NS, Leske J, Schroeter K. Moral distress in critical care nursing: The state of the science. Nurs Ethics. 2018;25(5):552-70.
  13. Young PD, Rushton CH. A concept analysis of moral resilience. Nurs Outlook. 2017;65(5):579-87.
  14. Mc Combs School of Business. Texas: Ethics unwrapped. (accessed 29 July 2019)
  15. 15.0 15.1 15.2 Triezenberg HL, Davis CM. Beyond the Code of Ethics:Educating Physical Therapist for their Role as Moral Agents. Journal of Physical Therapy Education. 2000;14(3):48-58
  16. 16.0 16.1 16.2 Edwards I, Delany CM, Townsend AF, Swisher LL. Moral Agency as Enacted Justice: A Clinical and Ethical Decision-Making Framework for Responding to Health Inequities and Social Injustice. Physical Therapy. 2011;91(11):1653–1663
  17. 17.0 17.1 17.2 Raines D. Moral Agency in Nursing. Nurs Forum. 1994; 29(1): 5-11.