From this paper, it is clear that there are several major flaws in both the methodology and the ethical considerations of the proposed study, as well as errors in some of the basic assumptions upon which the proposed methodology described in this grant has been based…
One major ethical consideration in this proposal is the interview process, which then requests that the treating physician provide the requested treatment to the study group. While the methodology does state that the treatment requested cannot be given if the treating therapist believes that it may cause harm to the patient, it does not make allowances for the patients best interest as viewed by the practitioner. Simply because the requested treatment does not cause harm does not mean that it is the most effective treatment for a given patient.
One basic assumption for this study is that patient-requested treatments will, in the end, approximate standard clinical treatment practices. However, this assumption puts a great amount of trust and faith in the educational level of the average physiotherapy patient. Physiotherapists undergo years of training, followed by continuing education for the rest of their career. Patients cannot simply select a treatment, based on at best a limited understanding of the issues at hand and at worst direct-to-consumer medical advertising or anecdotal evidence, and have a practitioner simply provide such therapy. The ethical implications in this situation are quite clear: while the patients' desires should be foremost in the mind of any medical practitioner, it is not ethical to allow the patient to make decisions without assistance in evaluating the available options (Slowther, 2010).
An additional ethical consideration falls under the modified informed consent plan listed in this grant. According to the grant, those consenting patients who are assigned to the intervention group “may choose standard consultation as a real option”. This statement seems nonsensical given the proposed methodology. I hope that the committee requests that the researchers involved in this grant to submit a modified proposal for review. The hypothesis proposed in this grant has great implications for the ethics of patient selection in their own medical treatment, should it be proven that educated and competent patient choice alone can improve patient outcomes for the same therapies being provided. This study is exactly the type of research that this committee is designed to support. With a modified methodology and the ethical considerations addressed, I would definitely be able to reconsider my recommendation.
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The basic assumption for this study is that patient-requested treatments will approximate standard clinical treatment practices. This assumption puts a great amount of trust and faith in the educational level of the average physiotherapy patient. Physiotherapists undergo years of training, followed by continuing education for the rest of their career.
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