Educating for Moral Action: A Sourcebook in Health and Rehabilitation Ethics.

Educating for Moral Action: A Sourcebook in Health and Rehabilitation Ethics Purtilo RB, Jensen GM, Royeen CB, eds. Philadelphia, PA 19103, FA Davis Co, 2005, hardcover, 318 pp, illus, ISBN: 0-8036-1261-3, $69.

Many books inform us about ethical concepts, but it is a rare text that encourages readers to examine curricular course-work and clinical practice unflinchingly for the presence of ethical values that direct our professional practice. This book is not for the complacent, because it challenges the reader to accept that moral and ethical competencies have expanded the roles we must assume as individuals, as professionals, and as members of a world community. Three editors are joined by 24 contributing authors from nursing, occupational therapy, or physical therapy and who have years of expertise in clinical practice, ethics, and teaching. They propose that, in the future, educators, administrators, and clinical instructors should be encouraged to broaden their perspectives concerning the ethical issues that affect modern clinical practice.

The clear writing style of the contributors, combined with a logical organizational style, prevents the depth and breadth of information from overwhelming the reader. The book is subdivided into 3 sections that examine different aspects of the themes of ethics: connectedness, reflection, and social responsibility. Each of the 27 chapters begins with an abstract that outlines the chapter's central ideas and ends with an extensive reference list. Authors of subsequent chapters introduce content that builds on the concepts discussed in earlier chapters without unnecessary repetition or overlapping. The editors and contributing authors present material in a framework that offers more of a "why to" rather than an instructional "how to" on teaching about the impact of ethical issues on the practice of our professions.

The first section, "Broadening Our Worldview of Ethics," includes 7 chapters that examine the concepts of ethical thought as they developed in various cultures. The chapters offer both historical and cultural perspectives on the topic of ethics. By discussing ethics using familiar terms such as autonomy, culture, self-respect, competence, and community responsibility, the authors enable readers to grasp the relationship between the ethical content and the practice environment in which it is applied. They emphasize that our growth and development as practitioners is accompanied by the responsibility to continually evaluate whether we approach therapeutic interactions with enough of an "other-centered" attitude (ie, one that places the patient's needs and desires ahead of our own) to be considered truly competent providers.

The second section, "Health Care Environment: Contextualizing Ethics," consists of 10 chapters that examine the real-world application of ethics. Professional association guidelines, clinical practice policies and procedures, health care technology, and the changing reimbursement climate are some of the topics addressed to highlight the need for practitioners to take action as agents of moral change. To meet this responsibility, the authors believe that our view of best practice must incorporate additional factors along with evidence to allow an integration of the art and the science of practice.

The third section, "Transforming Ethics Education: Strategies for Student Learning," consists of 10 chapters that offer an overview of educational approaches, strategies, and curricular models. The authors offer suggestions to guide educators through the process of envisioning and designing courses that will encourage and teach students to make moral judgments. This section begins with a reflection on the importance of mindfulness, a state of fully attending to all levels and nuances of an event, as a way to increase our level of connectedness with patients, fellow practitioners, and the practice environment. Practicing fully in the present, rather than in a rote or superficial manner, the authors argue, requires practitioners to continually engage in reflection. By modeling an approach that uses reflection to make professional decisions in clinical scenarios, the instructor transforms the student learning process into a reflection on how our daily actions affect our ability to deliver ethical care. Chapters on spirituality and moral courage provide guidance on how to structure learning opportunities so that our students will develop the inner strength to follow the often difficult path toward ethical clinical practice.

Although intended for educators, the book's potential would be greatly diminished if its distribution did not exceed the targeted population. All practitioners could benefit from grappling with ethical issues and examining how their current practice philosophy compares with the ideals of moral practice. This is reinforced in Elizabeth Mostrom's chapter, which provides examples that highlight the influence of attitudes and behavior modeled by clinical practitioners. Mostrom points out that actions observed during clinical experiences can determine whether students will internalize the ethical principles learned in the classroom or be content to criticize principles that they see as irrelevant in daily clinical practice.

This book is a useful resource for any educator, administrator, or clinician, whether they are just beginning practice or are experienced. It raises thought-provoking questions that encourage personal reflection on the role of ethics in our educational and professional lives. These questions may serve as a catalyst for change in how we define our professions to society.

Denise Gaffigan Bender, PT, JD, GCS University of Oklahoma Health Sciences Center Oklahoma City, Okla

Ms Bender is Associate Professor in the Department of Rehabilitation Sciences Program in Physical Therapy and an attorney licensed in Oklahoma. She teaches in the area of administration, professional issues, law and medicine, and geriatrics.