Chapter 6: Caring for Patients

INTRODUCTION

Like other health-care professions, physical therapy exists as a caring response to human maladies—suffering, disease, injury, and disability. Accordingly, the central norm for health-care professionals is caring, or what is called the principle of beneficence: the moral requirement to promote the well-being of patients. Caring for patients implies and is limited by respect for autonomy and also by professional standards of “due care,” as discussed in chapters 2 and 3. Here we take up several additional aspects of caring for patients: patients’ experience of illness; the interaction between patients’ medical good and their total good; and spirituality. We also discuss questions about professional distance and issues of character and the role of caring motives in promoting health care.

“Caring” has several relevant meanings. Health-care professionals are caregivers (service providers) who have responsibilities to take care of patients (provide appropriate services) according to contractual obligations, state-of-the-art standards of competency in the profession, and respect for patients’ autonomy. In meeting their responsibilities, therapists must be careful (cautious) in dealing with risks, take care (be conscientious) in meeting responsibilities, and exercise due care (reasonable caution) to meet standards of professional competence. Their work requires developing good “bedside manners” in showing care (presenting themselves as concerned and considerate).

Professionals could “show care,” however, without genuinely caring about (being benevolent regarding) their patients—in other words, without having positive attitudes toward them. A show of care might only be an elaborate game of appearances and pretense aimed at maintaining a profitable practice. That is, professionals could engage in helping actions (beneficence) without having caring motives and character (benevolence). Should therapists aspire to be caring persons (benevolent) who are genuinely concerned to help patients for the sake of patients, and not simply to earn a living? Does such caring tend to interfere with the professional distance needed for objective judgment and successful coping with the stresses of work? Does caring cause professionals to become care-ridden (burdened with anxiety), to be debilitated by “compassion fatigue,” and even involved inappropriately (either emotionally or sexually) with patients? We will work toward answers to these questions in this chapter.

EXPERIENCES OF ILLNESS

It will be helpful to distinguish between a malady and an illness.^1,2 A malady is a negative medical condition, such as pain, disability, injury, disorder, loss of freedom, loss of pleasure, dying, or an elevated risk of suffering such harms. An illness—or feeling ill—is how a malady (or what one believes is a malady) is experienced by an individual. Accordingly, persons might be diseased or injured but not ill. For example, a person may have degenerative lumbar disk disease but not experience low back pain ...