Physiotherapy and Fundamental Ethics - Questioning Self and Other in Theory and Practice
Physiotherapy and Fundamental Ethics engages the field of physiotherapy through a critique of its contemporary foundations from the perspective of the ethics philosophy of Emmannuel Levinas, in order to develop novel approaches to physiotherapy practice. Physiotherapy is a well-established healthcare profession, practiced in healthcare systems around the world. Despite its success, modern healthcare more generally faces a number of significant challenges, including increasing financial burdens, an increasingly ageing and chronically ill population, ongoing technological innovation, and diminishing trust in conventional healthcare. Ways in which physiotherapy could respond to these challenges and adapt to future needs are being explored. One approach entails a thorough reassessment of the profession’s status quo and its subsequent development, drawing on hitherto unexamined philosophies, methodologies, and practices. This study seeks to contribute to these efforts by drawing on a range of traditions that have not yet been introduced to the profession, but appear to hold great potential for its critical reassessment and development.
Levinas’s fundamental ethics provides the theoretical framework for this, beginning with its exposition of the ontological and epistemological underpinnings of Western metaphysics and science as implicating a violence against the other. This violence consists in negating the other and any relation to otherness through a totalizing movement, assimilating the other into the categories and capacities of the knowing ego, its knowledge, and self. Consonant with researchers who consider implications of Levinas’s work to other healthcare professions, I argue that Levinassian ethics reveals the theories and practices that shape contemporary physiotherapy as inadvertently opposing its original therapeutic motives and aspirations. By arguing that the other is characterised by a preceding and un-encompassable infinity and exteriority, Levinas developed his contrasting conceptions of fundamental ethics and the self-in-relation as otherwise than being. These provide the theoretical grounds on which I develop a novel understanding of the physiotherapist and physiotherapy practice. They are developed around the key notions of passivity and accompaniment drawn from Levinassian literature and further expanded throughout this thesis. Inasmuch as ethics as passivity and accompaniment questions the very possibility of practice without doing violence, I draw on Pierre Hadot’s approach to philosophy as a way of life, and the philosophies and practices of predominantly Japanese lineages of Zen(-buddhism), Aikido and other martial arts, and the treatment approach, Shiatsu. Building on their distinct emphases on physical practice and a resonance between them that I elucidate, I argue that they provide particularly fertile grounds for the development of otherwise physiotherapy practices.
Autoethnography provides the methodological point of departure, as this study sets out from my personal involvements in physiotherapy and the Japanese philosophical, martial, and therapeutic traditions. Autoethnography was adapted in this thesis through a critical encounter with Levinas’s and Hadot’s work. This consolidated the contrasting and conjunctural encounter of physiotherapy with fundamental ethics and other philosophies and practices for physiotherapy’s critique and development. Through this methodological engagement with Levinas and Hadot, the research offers a novel development of autoethnography to the fields of qualitative research. Its broad reference-field further indicates contributions that inflect across these fields, including other healthcare professions underpinned by the same ontology and epistemology. The primary aims of this study remain the development of a critical perspective that expands on Levinas’s fundamental ethics, and the development of novel approaches to physiotherapy on this basis.