Podiatry Students Unethical?

Not at all! As I said last week, the 4th year Podiatry Students at the University of Johannesburg(UJ), had their first taste of me starting the lectures on Practice Management and Ethics. There are many concepts to take on board including grasping the difference between ethical values & standards – represented by core values which are aspirational or value-oriented – such as Respect for persons, Human rights, Truthfulness,  etc., and ethical guidelines -represented by specific rules or duties associated with professional practice. We started to examine the challenges faced in daily practice and led into how we apply ethical reasoning to move from the understanding of guidelines to using them to influence our practical decision making and choices.

I’m usually never short of a word or two on most subjects! But beginning this course has made me think very hard again at the way in which I reach and make my day to day decisions. So just for fun!!! Let’s look at the 4 steps of ethical reasoning:

The problem: formulate  the problem and ask is there a better way of understanding it?    

Information: gather all the relevant data, clinical, personal, social etc.

Options: under the circumstances, consider all reasonable options, choices or actions.

Moral assessment: weigh the ethical content of each option by asking –

  •     what are the likely consequences of each option
  •     what are the most important values, duties and rights? which is strongest?
  •     what are the weaknesses of your view?
  •     how would you want to be treated in the circumstances of the case? i.e. apply the Golden Rule

(I acknowledge the Health Professions Council of South Africa (HPCSA) as the source of the above).

Easy isn’t it? Hopefully someone at the HPCSA will be able to tell me this week what the Golden Rule is, I think I know but I’d better get the official opinion on it!

Naturally we are all making choices every moment of our lives, some better some worse, but getting into deep philosophical discussions can be quite daunting – especially when all most of us want to do is practise our profession.(Oh, and make lots of money!)

Perhaps as you read this you should start to apply some ethical reasoning to why you should or should not book an appointment with your podiatrist. Are you a person with diabetes who hasn’t had a diabetic foot assessment recently or ever? Have you any idea what a podiatrist can do to help your feet if you suffer from some form of arthritis? Are your children normal or do they have some biomechanical anomaly (odd alignment) that is undiagnosed but could be treated by a podiatrist? Do you care if your Gran can’t cut her toenails? Do you really have to but another pair of running shoes to get relief from foot and leg pain or should see a podiatrist? Is it possible that a podiatry consult could shed some light on the cause of by chronic back pain?

This morning I saw the effects of good podiatry care in a 5 year old who has good foot alignment although she has rheumatoid arthritis. She has been wearing foot orthotics for one year and has not developed any deformity in this time. As part of the team at Chris Hani Baragwanath Hospital I hope that the future choices we make will produce such pleasing results. It comes as a surprise to most people that children can suffer with arthritis, so I’m going to write about this during the next few weeks.

In the mean time spare a thought for my students who must be faced with ethical decisions about whether they should do the assigned reading for this week or go to the movies in the hope that  I’ve got it all sorted!


Andrew has taught at the University as well as providing podiatry services in South Africa since 1977. Twice chair of the Podiatry Association of South Africa and a commentator on care of your feet on both radio and television he now works in private practice in Cape Town and Hout Bay.

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