Fysioterapeuten 9-2017

FYSIOTERAPEUTEN 9/17 39 justice (12–16). Physiotherapists must the- refore carefully consider whether their ap- proaches enable participants (and their fa- milies) to exercise freedom of choice about entering treatment (autonomy); ensure that the child/adolescent receives a net benefit by participating in the program (beneficence and non-maleficence); and ensure that the program’s inclusion criteria are reasonable (justice). These bio-ethical principles make it incumbent on those seeking to change lifestyles to offer treatment that is both ef- fective and geared to the well-being of the child/adolescent (and their parents) (9,13). Barbara Gibson, however, argues that physiotherapy practice often involves ethi- cal challenges not easily identified by the ap- plication of traditional bio-ethical principles (17). In an attempt to reframe moral practice in terms of commitment to doubt and open- ness (17–18), Gibson sketches an alternative set of ethics, a critical physiotherapy ethics whose core feature involves the discovery or identification of ethical moments . Gibson argues that openness to such moments can help us perforate tacit habits of thought in physiotherapy, avoiding stagnation and ope- ning up new possibilities for practice (17, pp. 12–16). They also provide an opportunity to question such dualities as obese and normal weight, successful and non-successful, acti- ve and inactive: binaries which Gibson sees as ingrained in Western thinking (including traditional bioethical principles). She argues that this makes it challenging for health pro- fessionals to reflect critically on their own practice: for example, in relation to testing and the ethical issues implicit in its practice. She sets out to delineate an alternative ap- proach capable of offering greater insight into the complex outcomes of physiotherapy practice, including those which are uninte- nded, potentially harmful, and largely tacit. Gibson’s ethics of openness Gibson’s alternative to traditional bioethics draws upon postmodern and critical scho- larship with their shared critique of the do- minance of positivism (17): Post-critical work rejects the assump- tions of an objective, neutral and value-free science and posits that all knowledge is perspectival (i.e. we al- ways observe something from a certain viewpoint) ... Post-critical approaches thus are focused on uncovering what is taken for granted as true or given and, without necessarily rejecting these «truths» acknowledge that they are pro- visional and always open to revision. (17, pp. 5-6) . Gibson argues for a post-critical ethics – an ethics of openness – that problematizes established guidelines and principles, ena- bles physiotherapists constantly to chal- lenge implicit norms and assumptions, and encourages openness to new possibilities for practice (17,18). While acknowledging that physiotherapy as traditionally practiced may be helpful in many ways she questions the readiness of physiotherapists to test, treat and change bodies that deviate from (pre)-established norms (17). As she notes, regarding bodies as problems that need to be rehabilitated and changed has unintended results – ones that are rarely identified by practitioners or debated within a profession whose ethics have been mostly concerned with the risks and benefits of treatment (18). In contrast, an ethics of openness involves the ongoing interrogation of entrenched, habitual physiotherapy practices, including those which are evidence-based. Openness, then, is about doubt. Or as Gibson puts it: «an ethics of openness emer- ges from a position of doubt in which there is no predetermined right way to practice. (…) It has to be established along the way (…).» (18, pp. 140–141). It involves searching for implicit, taken-for-granted notions that have developed into tacit aspects of physio- therapy practice. For Gibson: Ingrained ideas, practices and princi- ples are never settled, but always open to revision. Moreover, it is perhaps those practices that appear devoid of ethical content that require the closest scrutiny. An ethic of openness like all critical work requires ongoing com- mitment to thinking against the grain. (18, p, x) . Methods This article draws on empirical data from a Norway-based study of interdisciplinary group-based lifestyle programs. Approved by the Norwegian Social Sciences Data Ser- vice (NSD), the study was conducted ac- cording to strict ethical criteria. Potential participants were fully informed about the nature of the research, and all those selected gave their written consent. At every stage care was taken to preserve the confidential- ity of participants, including the use of fic- tive names and the omission of details that could identify them. As part of this research, Groven intervi- ewed children and adolescents participating in one particular program. She also intervi- ewed physiotherapists working in a variety of Norwegian lifestyle programs. In this ar- ticle we present and explore two case stories in an attempt to demonstrate how Gibson’s post-critical ethics can be utilized in lifestyle Gibson’s approach of critical ethics enables physiotherapists to open up and develop our future practice. Implications • In lifestyle programs where physio- therapists encounter children and adolescents with obesity they must recognize the need for effective treat- ment along with the consideration for the well-being of the participating child/ adolescent. • In helping physiotherapists to avoid doing more harm than good, Gibson sketches an alternative ethics – a critical physiotherapy ethics seeking to reframe moral practice in terms of com- mitment to doubt and openness. • Embracing such a critical ethical approach is not easy, as it requires a radical shift in habits of thought. Ho- wever, by opening up and questioning status quo, our profession can approach and develop future practice within the obesity field.