Autonomy and the future of (speaking about) physiotherapy in New Zealand.
Professor Paris has described this policy as censorship; a violation of free speech; a violation of academic freedom; and a loss of professional autonomy. Given the interest in Professor Paris's commentary, the debate that has played out in the pages of this Journal, and the ramifications of this policy on the academy of physiotherapy in this country, it seems appropriate to engage the physiotherapy community in the debate through the Editorial pages of our journal.
These are serious matters for a profession to face, so we must seriously consider the extent to which these threats Professor Paris describes are inherent in the Board policy of requiring visiting overseas presenters to hold special purpose scope registration. Are there benefits substantive enough to outweigh the risks, and how should we proceed toward a commonsense balance of risk and benefit?
Academic freedom is enshrined in section 161(2) of the Education Act 1989 (Maharey 2001). This section of the Act primarily covers employees of public educational and research institutions, outlining the principle of academic freedom, and academia's role to serve as critic and conscience of society. At least to the extent that the Board's policy affects the ability of universities to host visiting scholars, it is conceivable that it may affect the freedom of the institution and its staff to regulate the subject matter of courses taught at the institution. It may also conceivably affect the freedom of academic staff and students to question and test received wisdom, to put forward new ideas and to state controversial or unpopular opinion, if the university wished to invite an overseas academic to speak on such matters (Mercer & Jones, 2002, Mercer et al 2002). However the principle of academic freedom has wider application than the legislative reach of the Act. So, as an academic profession, if we extend the principle to professional conferences, workshops and seminars, the potential threat to the principle of academic freedom from the Board's policy becomes more apparent.
If presenters must have been granted special purpose scope registration by the PBNZ to speak in New Zealand; by the same logic, should not authors also be required to have special purpose scope registration to publish or distribute their writing in New Zealand? If conference organisers must ensure that all speakers in a conference hold special purpose scope registration, should I, as Editor of the New Zealand Journal of Physiotherapy, insist that overseas authors submitting articles to the Journal must first seek special purpose scope registration with the PBNZ before I can consider publication? Will the Board insist on this, next?
What about textbooks written by overseas authors? Burn them! The New Zealand public must be protected! New Zealand physiotherapists, according to our Board, cannot be trusted to critically judge the soundness of the authors' content without Big Sister the Board checking their bona fides.
Where does it stop? Internet sites? Find out from the Chinese government urgently how to block them. What about Manuale D'Amore 2, a movie currently touring New Zealand with the 13th Italian Film Festival, in which physiotherapist Lucia, played by the gorgeous Monica Belluci, becomes embroiled in an steamy relazione with paraplegic patient Nicolas? It must be banned: not only to protect the public lest New Zealand physiotherapists start employing some of Lucia's techniques, but because director Giovanni Veronesi does not (as far as I am aware) hold special purpose scope registration from the PBNZ to present his film on these shores.
Ridiculous? Yes, I've taken this path to an absurd but not illogical end, but when we take even one or two steps down this path, we begin to see what a slippery slope we tread.
Is "protection of the public" a valid argument for the Board's policy of requiring visiting overseas presenters to hold special purpose scope registration? Does not the duty of care in any engagement between health professional and patient lie with the individual health professional providing the care, rather than whoever or wherever they learned it from? It is the individual health professional providing the care who is responsible for ensuring the treatment given is sound and appropriate. The visiting speaker who presented a seminar about that treatment is not responsible for any harm that might come from a practitioner applying the treatment: it is the practitioner who is responsible. It is not the Board that has the responsibility for deciding whether information presented by any speaker is fit to be heard here: it is the individual health professional--who is responsible for the care he or she provides--who must critically evaluate any new information in his or her field, whether it is disseminated in an oral presentation, a textbook, a course manual, or on the internet.
The presenter of a lecture, course, or conference presentation typically has no direct contact with the potentially vulnerable public: there is no direct opportunity for harm to patients or the lay public. The audience are a willing, informed group of professionals, with the capacity, borne of their professional education, and a responsibility to critically appraise what they hear, and read, and see. Is it not an insult to their intelligence; an affront to their professional acumen, for the PBNZ to censor what they may hear (or read or see)?
Could it be that requiring PBNZ registration of presenters at lectures and conferences undermines the responsibility incumbent on the individual healthcare provider? It could be taken to imply that the presenter, and the information presented, has the official sanction of the Board. Can the individual health professional therefore feel assured that the content of the presentation is all valid and legit, because it has the blessing of the Board? Give up responsibility for critical thinking to the Board? If something presented is later found to cause harm, who is responsible for that harm? Will the Board be liable, having assumed responsibility for allowing the information to be presented?
Our respondents, Dr Laslett and Mr McKenzie, report that they have never been required to register with the regulatory authorities in any country in which they have spoken to physiotherapist audiences in a professional capacity. In addition to threats against autonomy and free speech, barriers to the free exchange of innovative ideas and debate bring stifling and potentially deleterious effects to the profession (Paris 2008). Our country is isolated enough by the tyranny of distance; further barriers to local professionals engaging with international intellectual debate should be discouraged.
In past years, New Zealand has hosted international conferences for a variety of fields of physiotherapy practice, for example IFOMT 1977, the International Federation of Orthopaedic Manipulative Therapists International Congress in Christchurch. Will New Zealand be able to host such wonderful, stimulating events for the profession in the future? IFOMT 2008 in Rotterdam reviewed over 250 abstracts for presentation. At WCPT 2007, the World Confederation for Physical Therapy Congress in Vancouver, over 700 platform presentations were delivered, and almost 1000 research and special interest posters presented. Does the PBNZ have the capacity to deal with 1700 special purpose scope of registration applications? Or even 250? Is it really necessary to "protect the public and the profession" from these contributing presenters? Faced with an additional charge of NZ$180, payable to the PBNZ, for the privilege of flying to New Zealand to present their work to their own colleagues, what proportion would decide against coming, and choose instead to conference in a more welcoming, collegial country?
In the coming months a friend and colleague will be visiting New Zealand. She is coming to walk the Milford Track, among other recreational pursuits, and will visit me in Dunedin. She is an accomplished researcher, a leader in her field, so I would like to give my post-graduate students the opportunity to meet her. Should I instruct her that she may not speak about physiotherapy while in New Zealand, as the Board has not had the opportunity to assess her potential risk to the public and the profession? If I were to invite her along to present a short seminar, or join in our Journal Club followed by social drinks, must she be registered with the PBNZ for a special purpose scope of practice? If she doesn't register, but talks to my students as a group, could she be arrested? Could I be arrested? What would the charges be? What are the consequences? These are questions the Board has been unable to answer.
Importantly, what would be the consequences to the reputation of the profession in New Zealand should a well-regarded international researcher be prevented by our Board from speaking here, or charged with an offense for doing so?
So, as an autonomous, self-regulating profession, how should we proceed? To my knowledge, no other country requires a license to talk--even the most litigious nations and states of the world--so should we? My inquiries suggest that neither the Medical nor Dental regulatory authorities require registration to present at conferences--so should our regulatory authority be out of step?
There is no question that any patient contact requires registration and an annual practising certificate. What about teaching practical courses, in which the instructor demonstrates techniques on healthy volunteers? What about teaching block courses in university curricula? Should these be treated the same as a short conference presentation? I do not dispute that teaching and research are a part of the practise of physiotherapy, but how should we approach the issue of visitors who do only that, and no other aspect of practice, for only a temporary visit? How do we distinguish between the potentially vulnerable--patients, the public--and a willing, informed professional audience?
These are questions that the physiotherapy community must consider, in deciding how we want to self-regulate our profession. If we are indeed an autonomous profession, we must be self-regulating, so we must instruct the Board what regulations we wish to apply, and rely on the Board to enact them within the framework of existing legislation. The Board consulted with the profession on this topic a year ago, with no changes yet announced. The Board has more recently consulted the profession with respect to the general scope of practice. The Chair of the PBNZ, Hilary Godsall (Godsall 2008b), in the current issue of the Journal, has indicated that the Board may revisit the special purpose scope of registration following completion of their review of the general scope, in the near future. In the interests of autonomy and the future of physiotherapy, I hope this is a constructive dialogue.
Paris SV (2008): Autonomy and the future of physiotherapy. New Zealand Journal of Physiotherapy 36(2): 67-75.
Godsall H (2008a): Response to Paris SV: Autonomy and the future of physiotherapy. New Zealand Journal of Physiotherapy 36(2): 76.
McKenzie R (2008): Response to Paris SV: Autonomy and the future of physiotherapy. New Zealand Journal of Physiotherapy 36(3): 166.
Laslett M (2008): Response to Paris SV: Autonomy and the future of physiotherapy. New Zealand Journal of Physiotherapy 36(3): 166.
Maharey S (2001): Academic Freedom. In: Maharey S (2001): http://executive.govt.nz/MINISTER/maharey/teac-system/ report/chapter_09_01.htm. (Accessed 16 October, 2008) Mercer SR, Jones DG (2002): Physiotherapists in a university environment: the challenge to the profession. New Zealand Journal of Physiotherapy 30:18-21
Mercer SR, Galvin KA, Jones DG (2002): Academic freedom in physiotherapy teaching. Physiotherapy 88:5
303-306. Godsall H (2008b): Response to McKenzie R and Laslett M: Autonomy and the future of physiotherapy. New Zealand Journal of Physiotherapy 36(3): 167.
J. Haxby Abbott, PhD, MScPT, FNZCP
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|Author:||Abbott, J. Haxby|
|Publication:||New Zealand Journal of Physiotherapy|
|Article Type:||Conference news|
|Date:||Nov 1, 2008|
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