Stepping out of the shadows

Most participants also had little formal understanding of ethics, ethical issues or ethical decision making, and they did not consciously define ethical decisions as ethical. Rather, they thought of their ethical decisions as clinical decisions and used their tacit knowledge of ethics to make ethical decisions implicitly.Stepping out of the Shadows: The Learning of Ethical Conduct through the "I" and "Eye" of Physiotherapists is an empirical examination of how, when and where physiotherapists learn ethical conduct. Using a grounded theory approach, both narrative inquiry and deliberative inquiry were used to understand the practice of physiotherapy and the learning of ethical conduct in the profession from the point of view of 16 participants.Participants' narratives showed that physiotherapists learn ethical conduct experientially throughout their personal lives and professional careers, with most of the difficult learning occurring early in their careers. Learning ethical conduct is primarily self-taught; regardless of when they were educated, most physiotherapists received no explicit ethics education in either their formal or their continuing education.Despite this, most physiotherapists make good ethical choices. This is probably because physiotherapists rely heavily on their own life experiences and on a broad, supportive network of family members, friends, colleagues and experts to "teach" them about ethical conduct. Given these findings, a narrow view of ethics teaching or education should be avoided. Ethical conduct should instead be learned in a supportive environment where students, physiotherapists and other colleagues model ethical behaviour, share their stories of experience and discuss ethical issues with those they trust to advise and guide them. This supportive environment should extend to personal networks, professional resources and understandable, accessible information on ethics.Taken together, these findings point to a need to balance, or rebalance, the profession's current emphasis on science and evidence in the direction of greater emphasis on or development of the social science, qualitative and humanistic aspects of the profession.My research also found that ethical conduct is best learned when physiotherapists are competent in reflective practice, including self-awareness and self-evaluation, and equally comfortable with the humanist and evidence aspects of the practice of physiotherapy.