Listed as two of the 13 core ethical values and standards for good practice and conduct by the HPCSA (Health Professions Council of South Africa) when it comes to being a health professional are integrity and tolerance. This suggests that we as physiotherapists need to act responsibly, honestly and with morality, as well as respect the rights of coworkers and patients to have different ethical, personal, religious or cultural beliefs.
Currently in South Africa there are still incidents of discrimination such as racism, sexism, homophobia, and a general intolerance for other human beings in the health care environment from both patients and staff (Muller, 2017). South Africa, known for its wide variety of people and cultures, would be expected to have the most tolerance of all. Yet patients are still refusing specific doctors, nurses or rehab workers due to their demographics, as well as heath care professionals are feeling uncomfortable with certain patients due to their own personal or religious beliefs and morals (Genuis, 2013). Majority of studies and articles reference nursing staff, but describe how in many cases these verbal attacks become violent.
As a person with strong moral beliefs due to growing up in an inclusive and accepting environment these two values are held to high esteem within my daily practice. Unfortunately as health care professionals we encounter many people who are rigid in their ways and make doing the so called ‘right thing’ a challenge. Integrity and tolerance sometimes clash within one’s self as being a good physiotherapist to everyone and treating them responsibly becomes difficult in cases where a patient being treated expresses or follows beliefs or ideas that you don’t necessarily agree with or find morally acceptable (Genuis, 2013). Finding tolerance for those are often times a challenged and finding the extent of your own integrity to help them to your best ability becomes an internal fight. 
Studies also indicate the strong relationship between a good physiotherapist- patient relationship and intervention success. Thus having contradicting ideals or beliefs of bias that lead to intolerance and conflict between the two will only yield negative effects, even if treatment continues out of a sense of duty.A foundation of trust, respect and open communication about goals showed the best therapeutic results post physical therapy (Morera-Balaguer, 2018).
Many health professionals see the increasing prevalence of ethically challenging situations as a burden that is unwelcome, and therefore unintentionally or intentionally modifying some of their professional duties or refer to the ethical guidelines of their profession as the sole opinion (Genius2013).
Recently I was faced with a situation where I had acquired a patient with a recent below the knee amputation into my care and everything I stood for was challenged by the elderly man’s words and attitude. He was outwardly racist and sexist towards the care givers of the facility as well as myself, showing no signs of tolerance or respect to anyone trying to help him. Stuck in his harmful beliefs that he expected to be respected and heard, as it was his right. We are taught tolerance, respect and acceptance but how can one be expected to apply those beliefs to such a situation, where the beliefs of another are degrading and harmful to those around them. Thus leaving a grey space between what is right and wrong. Often these core ethical values are good in theory but need be viewed as a two way street between health care professionals and our patients in order to apply to the real world.
This patient would often call me over and talk to me as if I was on his side based on the colour of my skin and his. On the contrary I felt embarrassed by him and felt a sense of shame that I couldn’t place at the thought of others thinking I was associated with him, and that affected my ability to treat him anywhere other than the isolated gym area. Did this mean I was modifying my duties due to an inability to put aside my own core values and beliefs? Was I providing a less effective service because of my feeling? To what extent could i voice my own options to him as apposed to staying quite and not taking a stance in the matter? The line between what is right by me and what is right by the rules I follow as a health professional became increasingly unclear and confusing.
Many of the individuals involved felt verbally abused and disrespected, yet still went on to treat him as they felt it was their responsibility and the integrity for their profession that drove them onward despite the negative personal affects each interaction brought to them. No one thought to report it. They were just glad it did not get violent physically.
The following video (https://www.youtube.com/watch?v=1CEJnbPZG_g ) discussed the legal and ethical considerations when facing patients who are racist or degrading towards health professionals. The speaker explains how patients have a right to refuse any type of treatment from a health professional while health professionals have a duty to treat and cause no harm, without being forced to a work in a hostile environment. This links back to the above scenario where a patient was outwardly rude and derogatory towards the staff members of colour (98%), but he didn’t refuse treatment and finding a nurse or doctor he approved of was not possible at this specific facility. The only means to meet the patient’s demands was to discharge the patient or continue to treat an individual who was causing unnecessary harm to the staff. The speaker also discusses how we always see discrimination of any type as wrong, but we must also be aware of PTSD patients or previously mistreated patients who may react a certain way out of fear, not bigotry and hate, although this was not the case in the scenario.
The question here is, is it fair or even ethical to have to ignore some of your own beliefs and look past our own self-respect because we took an oath to help the patients entrusted to us. These ethical guidelines and values of the HPCSA suggest a duty to our patients (HPSCA, 2016), but one also has a duty to themselves.
References
Genuis, S. J., & Lipp, C. (2013). Ethical Diversity and the Role of Conscience in Clinical Medicine. International Journal of Family Medicine, 1-18.
HPCSA. (2016). GUIDELINES FOR GOOD PRACTICE IN THE HEALTHCARE PROFESSIONS booklet 1. Retrieved from Health Professions Council Of South Africa: https://www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/conduct_ethics/Booklet%201.pdf
Morera-Balaguer, J., & Botella-Rico, J. (2018). Physical therapists’ perceptions and experiences about barriers and facilitators of therapeutic patient-centred relationships during outpatient rehabilitation: a qualitative study. Brazilian Journal of Physical Therapy, 484-492.
Müller, A. (2017). Scrambling for access: availability, accessibility, acceptability and quality of healthcare for lesbian, gay, bisexual and transgender people in South Africa. BMC International Health and Human Rightsvolume .
Paul-Emile, K. (n.d.). Dealing with Racist Patients. Retrieved from 2018 Pediatric Bioethics Conferenace: https://www.youtube.com/watch?v=1CEJnbPZG_g
Image: https://oldenburgfranciscans.org/jpic-article/teaching-tolerance-not-hate/
2 thoughts on “Ethical Values: Integrity and Tolerance”
Hi Carla, thank you for highlighting this important factor of our careers especially in the Hospital setting.
Your arguments and questions are valid and true, it is difficult to deal with patients when they do not give you the same respect you give out.
I think it is better you put your reflection at the top of your piece followed by the rest of the content for a better flow.
Hi Carla, Thank you for sharing such thoughts. This is indeed a factor most health care professionals face, and I have encountered it before as well. Another thing that stands out for me is health care professionals disregarding the oath they took with no empathy because they are “fed up” about a certain patient. Yes, we can not tolerate such behaviors but how can we be equipped to better deal with them?
I think you can speak about your experience first and what thoughts came into mind, then literature to validate or rule out some things, I feel like that way your writing will flow nicely.
Overall, good grammar, I did not note any spelling errors and good referencing.
Apologies for the late comment, and all the best.