Understanding the lived experiences of patients: application of a phenomenological approach to ethics

This perspective article provides a justification, with an overview, of the use of phenomenological inquiry and the interpretation into the everyday ethical concerns of patients with disabilities. Disability is explored as a transformative process that involves physical, cognitive, and moral changes. This perspective article discusses the advantages of phenomenology to supplement and enhance the principlist process of ethical decision making that guides much of contemporary medical practice, including physical therapy. A phenomenological approach provides a more contextual approach to ethical decision making through probing, uncovering, and interpreting the meanings of "stories" of patients. This approach, in turn, provides for a more coherent and genuine application of ethical principles within the "textured life-world" of patients and their evolving values as they grapple with disability to make ethical and clinical decisions. The article begins with an in-depth discussion of the current literature about the phenomenology of people with disability. This literature review is followed by a discussion of the traditional principlist approach to making ethical decisions, which, in turn, is followed by a discussion of phenomenology and its tools for use in clinical inquiry and interpretation of the experiences of patients with disabilities. A specific case is presented that illustrates specific tools of phenomenology to uncover the moral context of disability from the perspective of patients. The article concludes with a discussion of clinical, educational, and research implications of a phenomenological approach to ethics and clinical decision making.