Business Ethics Journal Article
Journal Article Analysis Each student will select one of the key terms presented in the module and conduct a search of Campbellsville University’s online Library resources to find 1 recent peer-reviewed academic journal article (within the past 3 years) that closely relates to the concept. Your submission must include the following information in the following format: DEFINITION: a brief definition of the key term followed by the APA reference for the term; this does not count in the word requirement. SUMMARY: Summarize the article in your own words- this should be in the 150-200 word range. Be sure to note the article’s author, note their credentials and why we should put any weight behind his/her opinions, research or findings regarding the key term. DISCUSSION: Using 300-350 words, write a brief discussion, in your own words of how the article relates to the selected chapter Key Term. A discussion is not rehashing what was already stated in the article, but the opportunity for you to add value by sharing your experiences, thoughts and opinions. This is the most important part of the assignment. REFERENCES: All references must be listed at the bottom of the submission–in APA format. Be sure to use the headers in your submission to ensure that all aspects of the assignment are completed as required. Any form of plagiarism, including cutting and pasting, will result in zero points for the assignment .
The following terms for your research: Ethical Awareness
RESEARCH ARTICLE Open Access
Self-evaluated ethical competence of a
practicing physiotherapist: a national study
in Finland
Kati KULJU1* , Riitta SUHONEN2 , Pauli PUUKKA3, Anna TOLVANEN1 and Helena LEINO-KILPI4
: Patients have the right to equal, respectful treatment. Nowadays, one third of patient complaints
concern health care staff’s behavior towards patients. Ethically safe care requires ethical competence, which has
been addressed as a core competence in physiotherapy. It has been defined in terms of character strength, ethical
awareness, moral judgment skills in decision-making, and willingness to do good. The purpose of this study was to
analyze the ethical competence of practicing physiotherapists.
Method: A self-evaluation instrument (Physiotherapist’s Ethical Competence Evaluation Tool) based on an analysis
of a concept “ethical competence” was constructed in 2016 and physiotherapists (n = 839), working in public health
services or private practice responded to the questionnaire.
: Based on the results, most of the physiotherapists evaluated themselves highly ethically competent in all
areas of ethical competence, subscales being Strength, Awareness, Skills and Will. Willingness to do good was
evaluated as highest, while character strength, including the strength to support ethical processes and speak on
behalf of the patient, was evaluated the lowest. Physiotherapists most commonly consult a colleague when
encountering an ethical problem. Other methods for problem solving are not very familiar, neither are the
international or national ethical codes of conduct.
s: This was the first attempt to assess all aspects of ethical competence empirically in a clinical
environment in physiotherapy, using a novel self-evaluation instrument. Even if physiotherapists evaluate
themselves as competent in ethics, further exploration is needed for ethical awareness. Also the patients’
viewpoints about ethically competent care should be considered, to better ensure ethical safety of the patient.
Keywords: Ethical competence, Physiotherapy, Ethical awareness, Character strength, Self-evaluation, PECET
Background
Ethically safe care is a central goal of health care world-
wide [1]. All interaction with patients should be human-
oriented, recognizing more clearly an individual patient
in the center, to ensure dignity and respect in care [2].
This requires ethical competence of a professional and
can be acquired through educational interventions [3, 4].
Ethical competence is an important, foundational aspect
of health care professionals’ competence. It is considered
as a part of professional competence [2], about being
honest and loyal to patients [5], requiring abilities of
character, action and knowledge [6]. In health care the
concept has been defined in many ways – no consensus
on the definition can be found in the literature. Concept
analysis of ethical competence [7] defines the concept in
terms of character strength, ethical awareness, moral
judgment skills, and willingness to do good. Ethical
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data made available in this article, unless otherwise stated in a credit line to the data.
* Correspondence: kati.kulju@utu.fi
1Department of Nursing Science, University of Turku, FI-20014 Turku, Finland
Full list of author information is available at the end of the article
KULJU et al. BMC Medical Ethics (2020) 21:43
https://doi.org/10.1186/s12910-020-00469-3
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mailto:kati.kulju@utu.fi
competence needs support from the organization, and at
the personal level emerges from experience, knowledge
and communication. It results in positive outcomes for
the patient, professional and society [7]. An integrative
literature review [8] states several dimensions of ethical
competence, many of them corresponding to those in
the previous concept analysis, e.g. sensitivity as a part of
ethical awareness and reflection included in moral judg-
ment skills [8].
Physiotherapists as autonomous practitioners, and
often working in a multidisciplinary health care environ-
ment, also encounter unique and complex ethical chal-
lenges. These concern e.g. incompatibility of available
resources and patient’s needs [3, 9, 10], unethical behav-
ior of physiotherapists or other professionals and
realization of patients’ autonomy [3, 10]. Also close
physical and emotional relationship between the patient
and the physiotherapist creates specific ethical issues
[11, 12], such as how to maintain a professional proxim-
ity in the close and very often continued relationship. In
addition, ethical issues have raised questions about ac-
cess to physiotherapy [11, 13] and asymmetrical power
between the physiotherapist and the patient [12].
Physiotherapists need skills in clarifying their ethical
values and professional moral obligations and in making
decisions which are in the best interests of their patients
[14, 15]. In the European Qualifications Framework, by
the European Commission (2008), ethical competence is
described as an integral part of knowledge, skills and
competence, and as essential for the development of re-
sponsibility and autonomy [16]. The WHO Global Com-
petency Model (2012) states core qualities that are
related to ethical competence: active listening, responsi-
bility for one’s own work, ability to identify conflicts, re-
specting others’ individuality, acting confidentially and
according to the ethical and legal framework and per-
sonal values [17]. Important is being present, empathetic
and supportive and having a reciprocal relationship with
patients [18]. Among the core competences in physio-
therapy defined in a Finnish survey/Delphi study [19]
the ethical aspects were addressed as important and es-
pecially ethical sensitivity will be emphasized in the
future.
Health care educators, leaders and researchers need to
give high priority to the development of ethical compe-
tence of health professionals [20]. Ethical competence is
assumed to be acquired for example through role
models and experience [5], through education and ex-
perimental learning in multiprofessional groups [21], by
case study method, role-playing [22] and ethics simula-
tions [23]. Ethics education increases ethical awareness
and the development of reflective and analytical skills [3,
24] and ethical theories should also be considered as
good ways to enhance ethical decision-making skills [3].
Clinical ethics consultations and facilitating mentorship
between professionals have been regarded as a good way
to assist physiotherapists to identify and negotiate the
ethical dimensions of their everyday practice [3, 14].
There are some documents that emphasize an essen-
tial knowledge base for ethical competence in health
care [16, 17, 25]. Physiotherapists have developed and
published their own code of ethics [26, 27], which
should support the professionals to clarify their obliga-
tions towards patient and the public, and the rights of
the patient. However, challenging ethical situations
occur in everyday practice when working in different
settings with a variety of patients having different ages,
values and attitudes, backgrounds and health situations.
It is also known that professionals are not very familiar
with their ethical codes and how to use them in real sit-
uations [12, 15, 28]. They rarely use ethical knowledge,
e.g. theoretical frameworks to analyze the ethical issues
raised in their practice [29].
Recently, care complaints from patients have raised
concerns about patients’ treatment – complaints about
health care staff’s attitudes and behaviors towards pa-
tients are common and discussed in public [30]. Uneth-
ical behavior of health care professionals can result in
patients’ diminished courage to ask about their treat-
ment and lack of activity in their own care [31], feelings
of depersonalization and ignorance [30] and thoughts of
somehow deserving bad treatment. The physiotherapist’s
opinion about what’s best for the patient can be com-
pletely foreign to the patient and in that situation, it is
difficult for the patient to make a commitment to care.
Patients want to be involved in their own care and
decision-making, which fosters active engagement in
physiotherapy [28, 32]. Ethically competent good care
results in the best possible solutions for the patients and
reduced moral distress of a professional, which is also an
important aspect when considering well-being at work
[5, 33].
As ethical competence is one of the core competencies
in physiotherapy, ethical competence should be continu-
ously evaluated [2]. Assessment of this competence is
important to be able to offer effective ethics education,
achieve ethical knowledge and skills through education
[34], as well as for achieving higher ethical competence
at the organizational level. Self-evaluation tool for ethical
issues could increase physiotherapists’ interest in ethics,
helping them to identify strengths and weaknesses that
need to be addressed and to develop critical skills for
analysis of their own work [35]. A sufficient theoretical
base of the concept has made it possible to precede from
conceptualization to measuring ethical competence
subjectively [36]. A comprehensive instrument which
could measure all the aspects of ethical competence in
the physiotherapy context has been lacking. Some
KULJU et al. BMC Medical Ethics (2020) 21:43 Page 2 of 11
instruments have been used to measure mainly parts of
ethical competence. In previous physiotherapy research,
ethical awareness has been studied as a constitutional as-
pect in ethical judgment skills (Moral Sensitivity Ques-
tionnaire – Revised; Measuring Instrument for Ethical
Sensitivity in the Therapeutic Sciences )[10, 37] and also
ethical judgment skills have been analyzed in physiother-
apy (Defining Issues test) [38].
The aim of the study
The aim of the study was to evaluate ethical competence
of practicing physiotherapists by using a novel self-
evaluation tool. In this tool, the dimensions under inves-
tigation concerned ethical awareness, character strength
and courage, willingness and skills in decision-making.
In the future, this tool will be offered to work as a
checklist for teachers, supervisors as well as for students
and physiotherapists themselves to think and evaluate
the skills to identify ethical problems and ethical judg-
ment skills. This study aims to answer the following re-
search questions:
What is the self-evaluated level of ethical competence
of physiotherapists? What demographics are associated
with the self-evaluated level of ethical competence?
A descriptive and correlational study design was used by
a cross-sectional questionnaire survey via Webropol 2.0
in spring–autumn 2016. A total sampling from the
Finnish Association of Physiotherapists’ membership
register was used to maximize variability in age, length
of work experience and practice setting. Physiotherapists
who had retired or were off work for other reasons (e.g.
maternity leave) were excluded. A total sample of 5719
physiotherapists working in various settings (outpatient
and inpatient physiotherapy facilities, in private practice)
and covering the whole of Finland were invited in this
study. A total of 839 valid, completed questionnaires
were received via Webropol (response rate 15%).
Survey instrument
A novel self-evaluation instrument based on the concept
analysis [7] and a literature review was used, including a
cover letter. The Physiotherapist’s Ethical Competence
Evaluation Tool (PECET) is a self-administered, mainly
structured questionnaire including two sections: (A)
demographic data and background information about
ethical knowledge and methods used for ethical
decision-making, and (B) self-evaluation of ethical com-
petence designed as a 4-point Likert-type scale consist-
ing of 59 items representing the phenomenon of ethical
competence and answering the question “I feel I succeed
in this area of ethical competence”, the anchors being
4 = ‘excellent’ and 1 = ‘not at all’. Section B consists of
four subscales according to the attributes defined in the
concept analysis [7]. The attributes defining ethical com-
petence were repeatedly presented by seven different au-
thors in the reviewed literature. They all illustrate the
professional’s personal characteristics: 1) Character
strength (12 items, e.g. “I have strength to work as an
advocate in client matters. I have strength to work as the
client needs, even if it is inconsistent with my own
values.”), 2) Awareness (17 items e.g. “I listen to the cli-
ent. I have sensitivity to identify an ethical dilemma in a
situation.”), 3) Skills (17 items e.g. “I know the ethical
codes guiding my work. My work is evidence-based.”)
and 4) Will (13 items e.g. “I want to act according to the
ethical guidelines. I want the patient’s best in all situa-
tions.”). (Table 1.)
When developing the questionnaire, two expert
panels were carried out to evaluate the relevance and
clarity of the items to enhance the content validity of
the questionnaire [39]. Expert panel I consisted of
PhD students in Nursing Science (n = 16) (health care
professionals, teachers, clinical specialists, health care
managers, physiotherapy clients) who had expertise in
ethics. Expert panel II consisted of practicing physio-
therapists, physiotherapy students and physiotherapy
teachers (n = 7). Revision of the items was carried out
after the panels. A pilot study was conducted with
physiotherapy students (n = 12) and practicing physio-
therapists (n = 15). Only minor technical changes for
tenses or redundant wording were made based on the
pilot study.
Data analysis
Data from a structured questionnaire were entered into
the SAS 9.1 (SAS Institute INC: Cary, NC, USA) statis-
tical software in order to undertake descriptive and in-
ferential statistics. Frequencies, percentages, means and
standard deviations (SDs) were used to describe the data.
The sum variables were calculated based on the theoret-
ical construct and the internal consistency of items of
Section B (Character strength, Awareness, Skills and
Will) was measured using Cronbach’s alpha coefficient
[40]. Cronbach’s alpha value of 0.70 has been recom-
mended as the lowest acceptable coefficient for a new
instrument [39]. The differences between the four sum
variables were analyzed by repeated measures analysis of
variance. The Tukey-Kramer adjustment for multiple
comparisons was used. The correlation between age and
working experience and sum variables was examined
using Pearson’s correlation test. T-test was used to ex-
plore the association between dichotomous variables
(e.g. gender, further ethics education, participation of
ethics committees etc.) and sum variables. In case of var-
iables with more than two categories (e.g. respondent’s
perception of the stage in ethical competence), an
KULJU et al. BMC Medical Ethics (2020) 21:43 Page 3 of 11
analysis of variance was used to test the association be-
tween background variables and sum variables of the
four subscales in ethical competence (section B). The
level of significance was defined as p < 0.05.
Ethical considerations
The University Ethics Committee approved this study.
The Finnish Association of Physiotherapists gave the
permission for data collection. The respondents were
Table 1 Items representing the phenomenon of ethical competence in the questionnaire (PECET)
Subscales Abbreviated items
Strength 1. promote the best of the client
2. act as an advocate of the client
3. work in cooperation with various professional groups
4. act independently
5. take care of own well-being
6. work according to client needs, even if it conflicts with own values
7. work according to client needs, even if it conflicts with organization’s values
8. have the courage to discuss difficult topics
9. support a colleague
10. be brave by nature
11. take the responsibility that the client gets good care despite of insufficient resources
12. take responsibility for the actions
Awareness 1. succeed in interaction with client
2. listen to the client
3. recognize the ethical problem
4. recognize the needs of client
5. respect the obligation of secrecy
6. can settle in client’s position
7. take into account client’s social background
8. take into account client’s cultural background
9. take into account client’s opinion
10. respect client’s dignity
11. respect client’s individuality
12. respect client’s self-determination
13. know when doing ethically right
14. aware of own values
15. aware of own attitudes
16. know that working environment can have an impact in ethical decision-making
17. aware of possible pre-emption towards clients
Skills 1. professional activity is guided by the ethics guidelines
2. know laws governing professional activity
3. client understands the purpose of therapy
4. client understands the possible consequences of therapy
5. ask client’s informed consent
6. use experts in ethical problem solving
7. use literature in ethical problem solving
8. use support from colleagues
9. act as a responsible expert in work by keeping track of new knowledge
10. recognize limits as a professional
11. work in multiprofessional cooperation in accordance with ethical principles
12. express myself clearly
13. identify the ethical conflict
14. work evidence-based
15. justify therapy choices
16. identify the need to educate more in ethics issues
17. decide on the therapeutic content together with the client
Will 1. act according to ethical values
2. treat clients equally
3. promote the client’s best
4. tell the truth to the client
5. act confidentially
6. act according to what I think is right
7. commit to providing high quality care
8. work evidence-based
9. get educated in ethics
10. act evidence-based
11. work in multiprofessional cooperation in accordance with ethical principles
12. justify therapy choices
13. decide on the therapeutic content together with the client
KULJU et al. BMC Medical Ethics (2020) 21:43 Page 4 of 11
given written information about the aim of the study
and informed that answering the questionnaire was con-
sidered as informed consent to participate the study.
Participation was voluntary. The anonymity of the sub-
jects and confidentiality were considered and protected
by treating the data anonymously and confidentially.
Results
Respondent characteristics
The physiotherapists’ (n = 839) mean age was 45 years
(range = 22–70), and the majority of them (90%) were
women. The distribution in gender between women and
men is the same as member structure of the Finnish As-
sociation of Physiotherapists (FAP, 2016). The mean
length of working experience was 18 years (range = 0–45
years) (Table 2). The respondents’ current job included
diverse areas in neurological, musculoskeletal, pediatric,
mental health, geriatric and occupational rehabilitation
in inpatient and outpatient care, both in public and in
private sectors. All respondents (n = 839) had a main de-
gree in physiotherapy either at polytechnic / university
of applied sciences or at college level. Some of them
(n = 81) had also educated themselves further at higher
level (e.g. Master in Health Sciences, PhD).
The respondents used different methods in ethical
problem solving and decision-making. When encounter-
ing an ethical challenge, physiotherapists mostly con-
sulted a colleague (93% of the respondents). Also
discussions in groups (69%) and use of ethics literature
(38%) were rather common methods to ease ethical
problem solving. Only 8% of the respondents had con-
sulted a specialist in ethics, ethical committees’ help had
been needed by 11% of the respondents and theories of
ethical decision-making used by 12% of the respondents.
Table 2 Respondents’ demographic data (n = 839)
n % Mean Median SD Min Max
Age (years) 839 44.53 46.00 11.57 22 70
Working experience (years) 839 18.10 18.00 11.79 0 45
Gender
Male 86 10
Female 753 90
Education 839
Polytechnic 414 49
College level 385 46
Othera 40 5
Work place 819
Public sector 392 48
Private sector 397 48
Otherb 30 4
Encountering of ethical problems at work 833
Yes 611 73
No 222 27
Frequency of encountering ethical problems 614
Daily 24 4
Weekly 122 20
Monthly 175 29
Rarely 293 48
Continuing education in ethics after graduation 838
Yes 166 20
No 672 80
Team / committee work in ethics 832
Yes 24 3
No 808 97
SD: standard deviation.
aonly the highest degree reported (MSc, PhD)
bunemployed, researcher, teacher
KULJU et al. BMC Medical Ethics (2020) 21:43 Page 5 of 11
Self-evaluation of ethical competence
In section B of the constructed instrument PECET,
physiotherapists evaluated themselves in four subscales
of ethical competence consistent with the theoretical
construct of the phenomenon [7]: Character strength,
ethical awareness, moral judgment skills and willingness
to do good (Table 1). Cronbach’s alphas were calculated
to evaluate the internal consistency of the total scale
(0.95) and its sum variables (0.76–0.90).
The respondents evaluated themselves highly ethically
competent in all subscales of ethical competence. Will-
ingness to do good, to act ethically, was evaluated as
highest, while character strength including the ability
and strength to support ethical processes and speak on
behalf of the patient, was evaluated lowest. All differ-
ences between the four subscales were significant (ad-
justed p = 0.028 or less). (Table 3.)
The older (r = 0.174, p < .0001) and the more experi-
enced (r = 0.135, p < .0001) the respondent was, the higher self-estimated value was in sum variable Skills. The connections between dichotomous variables gen-
der (Male/Female), further ethics education (Yes/No),
participation of ethics committees (teams; Yes/No), en-
countering ethical problems at work (Yes/No) and sum
variables were detected (Table 4; T-test). In total, partici-
pating in further ethics education and ethics committees
was associated with higher self-perceived ethical compe-
tence in all areas. In addition, female physiotherapists
considered themselves more competent than men in all
areas. Participating in ethical committees was not com-
mon, but the differences were clear. Respondents who
reported that they had not encountered ethical problems
in their work, considered themselves as competent com-
pared to those who had encountered ethical challenges
in their work.
The respondents’ self-estimated knowledge of different
documents essential for ethical competence varied quite
much. Overall, the respondents knew the Finnish Act on
the Status and Rights of Patients [41] quite well, the eth-
ical principles of World Confederation for Physical
Therapy were known poorly [26]. The Finnish Associ-
ation of Physiotherapists has their own codes of ethics
[27]. Those codes are known excellently by 13% of the
respondents, while 30% of the respondents know the
Finnish codes poorly or not at all. Those who reported
excellent or fairly good knowledge of the documents
evaluated themselves also more ethically competent in
all areas of ethical competence compared to those
reporting poor or no knowledge of the documents. The
results were statistically significant.(Table 5.)
Generally, the respondents were not very familiar
with different methods for ethical problem solving and
decision-making. The best (excellently or fairly well)
were known consulting a colleague (93%) and discus-
sions in groups (60%), while a minority of the respon-
dents knew excellently or fairly well ethical theories
(28%) and literature (31%) or other methods that could
be used to enhance ethical decision-making. Use of eth-
ical committees or ethics specialists were known rather
poorly or not at all by a majority of the respondents.
Those who reported excellent or fairly good knowledge
of the methods evaluated themselves also more ethic-
ally competent in all areas of ethical competence com-
pared to those reporting poor or no knowledge of the
methods. The results were statistically significant.
(Table 5.)
As illustrated in the background information of the re-
spondents, only 12% of respondents had used ethical
theories to ease ethical decision-making. These respon-
dents also evaluated statistically significantly higher their
ethical competence in the Skills sub-variable (p =
0.0049). The 11% who had needed help from ethical
committees, also had higher values in the Skills sub vari-
able (p = 0.0002), but also in the Character strength sub-
variable (p = 0.0001). One third of the respondents (38%)
had used ethical literature to help ethical problem solv-
ing. These respondents also evaluated statistically signifi-
cantly higher ethical competence in sub-variables
Character strength (p = <.0001), Skills (p = <.0001) and
Will (p = 0.0009). Overall, the better the respondents
knew different ways in ethical problem-solving and
decision-making (consulting an ethics specialist, consult-
ing a colleague, group work, ethics literature, theories,
committees, further ethics education), the higher they
evaluated themselves in ethical competence. This con-
nection was statistically significant in total PECET
(p = <.0001).
The aim of this study was to evaluate the ethical compe-
tence of a practicing physiotherapist by using a novel
self-evaluation tool in Finland. The total level of ethical
competence PECETtotal (Character strength, Awareness,
Skills and Will) was assessed quite high, at 3.58 (anchors
being 1 = not at all, 4 = excellent). Age and length of
working experience correlated with ethical judgment
skills. The older and more experienced the respondent
was, the higher the self-estimated value was in the sum
Table 3 Sum variables in self-evaluated ethical competence
Variable n Mean 1) SD Cronbach’s Alpha
Char Strength 834 3.23 0.32 0.76
Awareness 835 3.45 0.33 0.89
Skills 830 3.26 0.39 0.90
Will 830 3.56 0.34 0.88
PECET total 823 3.38 0.29 0.95
1) Scale 1 = not at all, 4 = excellent.
KULJU et al. BMC Medical Ethics (2020) 21:43 Page 6 of 11
variable Skills. This finding supports the previous study
of Höglund, Eriksson, and Helgesson [5] as they state
that ethical competence can be acquired through experi-
ence. Willingness to do good, to act ethically towards
beneficence of the patient, was evaluated as highest. Also
Praestegaard and Gard [12, 28] have highlighted that
physiotherapists desire to work for the patient’s well-
being.
It seems that physiotherapists still have different abil-
ities to recognize ethical issues: almost one third of the
respondents reported that they have never encountered
ethical problems in their practice. Interestingly, these re-
spondents considered themselves as ethically competent
as compared to those who have encountered ethical
challenges in their work. This comes to a question of
ethical awareness. If the ethical aspects of a situation are
not recognized, it is difficult to address any ethical prob-
lem [37] – physiotherapists need to be challenged to
practice identifying ethical issues and being ethically
conscious in all interaction with the patient [12, 28].
Physiotherapists are not very familiar with different
methods and aids that could be used in ethical judgment
and decision-making, such as ethics rounds, ethics com-
mittees, ethical theories or ethics literature. This finding
is consistent with previous studies [12, 29] which state
that physiotherapists rarely use ethical knowledge to
analyze ethical issues. Knowledge of the different
methods, but also knowledge of the different documents
related to ethical decision-making, are positively
associated with higher self-estimated ethical competence.
This finding follows the previous study of Delany [14]
and is also consistent with the concept analysis [7]
which states the knowledge of ethics to be the prerequis-
ite of ethical competence. Furthermore, further ethics
education is positively connected to physiotherapist’s
self-estimated ethical competence. That result is consist-
ent with previous research which notes that ethical com-
petence can be acquired through education [4, 21, 24].
Taking part in ethics education after graduation is still
very uncommon among physiotherapists (20% had par-
ticipated). To support the ethical competence of physio-
therapists, multidisciplinary ethics committees in health
care organizations and also ethics consultation and edu-
cation are available. The possibilities still vary among or-
ganizations to get consultation in ethical issues,
possibilities for all health care professionals to
strengthen their ethical competence, develop their eth-
ical knowledge, awareness and courage and moral judg-
ment skills, in ethics discussion groups, virtual ethics
labs or by playing ethics games.
Strengths and limitations
In the physiotherapy field, this was the first attempt to
assess all aspects of ethical competence empirically in a
clinical environment and the concept of ethical compe-
tence was for the first time operationalized in this ex-
tent. The PECET instrument needs further development
to be used as a checklist, thought-provoking tool as a
Table 4 The association between dichotomous variables gender, further ethics education, participation of ethics committees,
encountering ethical problems at work and sum variables
Character strength Awareness Skills Will PECET Total
n Mean SD Mean SD Mean SD Mean SD Mean SD
Gender
F 738 3.24 0.32 3.46 0.33 3.27 0.39 3.58 0.34 3.39 0.29
M 85 3.14 0.29 3.36 0.31 3.12 0.34 3.44 0.36 3.27 0.28
pa 0.0086 0.0093 0.0007 0.0003 0.0003
Further ethics education
Yes 165 3.31 0.33 3.50 0.34 3.40 0.38 3.63 0.32 3.46 0.30
No 668 3.20 0.31 3.44 0.32 3.22 0.38 3.55 0.34 3.35 0.29
pa <.0001 0.0305 <.0001 0.0055 <.0001
Ethics committees
Yes 24 3.50 0.30 3.72 0.25 3.56 0.32 3.76 0.19 3.64 0.22
No 803 3.21 0.32 3.44 0.32 3.25 0.38 3.56 0.34 3.37 0.29
pa <.0001 <.0001 <.0001 <.0001 <.0001
Encountering ethical problems
Yes 608 3.24 0.32 3.45 0.32 3.26 0.38 3.58 0.32 3.38 0.29
No 220 3.20 0.32 3.45 0.34 3.25 0.39 3.53 0.38 3.36 0.31
pa 0.1186 0.9775 0.6851 0.1426 0.4735
aT-test
KULJU et al. BMC Medical Ethics (2020) 21:43 Page 7 of 11
Table 5 Knowledge of the different key documents and ethical problem-solving methods and its connection to self-evaluated
ethical competence
Character strength Awareness Skills Will Total
Document/ Method n Mean SD Mean SD Mean SD Mean SD Mean SD
FAP a
Excellent 109 3.403 0.296 3.640 0.278 3.572 0.319 3.715 0.271 3.585 0.244
Fairly well 474 3.241 0.313 3.462 0.316 3.280 0.363 3.590 0.332 3.396 0.277
Rather poorly 216 3.121 0.295 3.334 0.324 3.086 0.340 3.440 0.346 3.248 0.275
Not at all 36 3.101 0.300 3.381 0.311 2.993 0.415 3.493 0.349 3.238 0.271
p <.0001 <.0001 <.0001 <.0001 <.0001
WCPT b
Excellent 20 3.625 0.198 3.743 0.239 3.794 0.209 3.903 0.125 3.763 0.140
Fairly well 179 3.294 0.336 3.544 0.327 3.417 0.347 3.649 0.322 3.481 0.285
Rather poorly 439 3.210 0.291 3.416 0.305 3.219 0.359 3.544 0.329 3.347 0.269
Not at all 195 3.154 0.326 3.404 0.348 3.132 0.401 3.489 0.358 3.230 0.302
p <.0001 <.0001 <.0001 <.0001 <.0001
ETENE c
Excellent 53 3.479 0.293 3.608 0.290 3.685 0.316 3.750 0.227 3.665 0.231
Fairly well 372 3.260 0.312 3.464 0.322 3.314 0.358 3.588 0.338 3.408 0.286
Rather poorly 326 3.185 0.307 3.414 0.314 3.173 0.353 3.530 0.337 3.326 0.271
Not at all 79 3.076 0.293 3.357 0.340 3.039 0.409 3.464 0.365 3.238 0.283
p <.0001 <.0001 <.0001 <.0001 <.0001
Act on the Status and Rights of Patients [41]
Excellent 139 3.381 0.313 3.617 0.291 3.552 0.336 3.689 0.286 3.567 0.260
Fairly well 479 3.222 0.305 3.430 0.328 3.242 0.352 3.561 0.335 3.364 0.281
Rather poorly 197 3.135 0.321 3.367 0.304 3.378 0.378 3.486 0.358 3.274 0.277
Not at all 18 3.128 0.212 3.556 0.317 3.436 0.436 3.542 0.403 3.313 0.261
p <.0001 <.0001 <.0001 <.0001 <.0001
Personal data act [42]
Excellent 120 3.391 0.315 3.622 0.301 3.534 0.356 3.679 0.292 3.563 0.273
Fairly well 437 3.235 0.307 3.447 0.328 3.273 0.363 3.581 0.338 3.384 0.284
Rather poorly 236 3.148 0.308 3.369 0.298 3.118 0.358 3.492 0.340 3.282 0.266
Not at all 38 3.110 0.297 3.448 0.344 3.049 0.404 3.487 0.386 3.281 0.292
p <.0001 <.0001 <.0001 <.0001 <.0001
Consulting a specialist in ethics
Excellent 11 3.614 0.323 3.786 0.297 3.818 0.239 3.795 0.211 3.762 0.227
Fairly well 66 3.337 0.313 3.546 0.299 3.460 0.327 3.608 0.323 3.493 0.265
Rather poorly 236 3.217 0.305 3.425 0.322 3.246 0.334 3.560 0.335 3.364 0.275
Not at all 333 3.189 0.304 3.421 0.322 3.144 0.382 3.538 0.337 3.324 0.284
p <.0001 <.0001 <.0001 0.0414 <.0001
Consulting a colleague
Excellent 288 3.295 0.313 3.489 0.325 3.326 0.370 3.598 0.322 3.428 0.284
Fairly well 210 3.135 0.282 3.389 0.302 3.145 0.347 3.538 0.335 3.302 0.260
Rather poorly 24 3.024 0.265 3.266 0.326 2.995 0.339 3.356 0.360 3.172 0.273
Not at all 12 3.128 0.453 3.399 0.357 3.015 0.525 3.385 0.414 3.264 0.391
p <.0001 0.0002 <.0001 0.0008 <.0001
KULJU et al. BMC Medical Ethics (2020) 21:43 Page 8 of 11
part of ethical reflection. Because the survey instrument
is a self-evaluation tool in nature, the respondents are
demanded to acquire and use self-reflection skills to
analyze their knowledge and action in quite a difficult
topic. How they use these skills is a question of validity
and raises a question about what actually is being mea-
sured with the self-evaluation tool. Ethics in clinical
practice can be very complicated and choosing how to
act depends on how a situation is interpreted. The re-
spondents assessed themselves very positively in all
dimensions of ethical competence, even though 27 % re-
ported that they have not encountered ethical problems
in their practice. This is a contradictory result that is dif-
ficult to justify and raises a question of validity of the
novel instrument. Attaching Ethical guidelines for phys-
iotherapists [27] and a definition of ethical problem to
the questionnaire would have facilitated answering the
questions. Besides ethical awareness, this may also be a
question of over assessment of knowledge and skills
[35]. However, self-assessment can increase the interest
Table 5 Knowledge of the different key documents and ethical problem-solving methods and its connection to self-evaluated
ethical competence (Continued)
Character strength Awareness Skills Will Total
Document/ Method n Mean SD Mean SD Mean SD Mean SD Mean SD
Theories in ethical decision-making
Excellent 16 3.483 0.332 3.625 0.368 3.597 0.363 3.748 0.310 3.616 0.297
Fairly well 212 3.308 0.307 3.523 0.332 3.430 0.346 3.643 0.320 3.482 0.279
Rather poorly 307 3.203 0.307 3.425 0.324 3.235 0.359 3.533 0.342 3.350 0.287
Not at all 268 3.187 0.319 3.429 0.316 3.141 0.384 3.545 0.332 3.328 0.278
p <.0001 0.0033 <.0001 0.0019 <.0001
Ethics literature
Excellent 26 3.503 0.270 3.744 0.243 3.707 0.283 3.875 0.161 3.714 0.189
Fairly well 195 3.307 0.300 3.497 0.320 3.399 0.345 3.627 0.296 3.460 0.266
Rather poorly 378 3.198 0.301 3.417 0.330 3.185 0.344 3.531 0.345 3.332 0.281
Not at all 115 3.107 0.322 3.381 0.305 3.021 0.377 3.469 0.354 3.251 0.271
p <.0001 <.0001 <.0001 <.0001 <.0001
Ethical committees
Excellent 34 3.370 0.358 3.623 0.345 3.539 0.394 3.666 0.337 3.558 0.316
Fairly well 134 3.329 0.338 3.527 0.293 3.397 0.318 3.668 0.281 3.483 0.250
Rather poorly 341 3.201 0.300 3.411 0.328 3.216 0.362 3.546 0.346 3.343 0.285
Not at all 204 3.162 0.301 3.412 0.319 3.114 0.388 3.500 0.343 3.301 0.281
p <.0001 <.0001 <.0001 <.0001 <.0001
Ethics education
Excellent 16 3.653 0.224 3.820 0.191 3.843 0.179 3.875 0.143 3.806 0.147
Fairly well 66 3.297 0.316 3.489 0.339 3.413 0.330 3.647 0.299 3.466 0.277
Rather poorly 364 3.229 0.314 3.430 0.321 3.246 0.352 3.559 0.344 3.366 0.280
Not at all 275 3.178 0.306 3.434 0.316 3.150 0.391 3.532 0.336 3.327 0.282
p <.0001 <.0001 <.0001 0.0002 <.0001
Group discussion
Excellent 113 3.345 0.324 3.563 0.311 3.436 0.352 3.662 0.285 3.505 0.271
Fairly well 259 3.202 0.300 3.429 0.305 3.228 0.341 3.575 0.324 3.358 0.262
Rather poorly 161 3.192 0.318 3.390 0.335 3.146 0.353 3.489 0.364 3.307 0.286
Not at all 87 3.126 0.277 3.403 0.313 3.034 0.408 3.498 0.348 3.269 0.282
p <.0001 <.0001 <.0001 <.0001 <.0001 aFinnish Association of Physiotherapists. 2014. Codes of Ethics [27] bWorld Confederation for Physical Therapy. 2011. Ethical Principles [26] cThe National Advisory Board on Social Welfare and Health Care Ethics. 2001. Shared values in health care, common goals and principles: Principles of Health Care Ethics [43]
KULJU et al. BMC Medical Ethics (2020) 21:43 Page 9 of 11
for ethical issues and enhance critical thinking among
physiotherapists to analyze their own work, which is an
essential component of lifelong learning [35]. The survey
instrument used in this study was constructed based on
a concept analysis of the concept ethical competence,
which formed a theoretically solid ground for the ques-
tionnaire. The internal consistency of the constructed
instrument was good, for the total scale 0.95 and be-
tween the sum variables Strength, Awareness, Skills and
Will 0.76–0.90 being acceptable [39].
The number of respondents (n = 839) was statistically
sufficient, but the response rate (15%) was low repre-
senting less than one fifth of all possible respondents
and thus, leading to low generalizability of the results.
The low response rate may be because the data were
collected electronically via Webropol. Also, the topic
may be perceived as difficult to think of or not consid-
ered as important as hands-on clinical skills. Since the
data were collected from the Finnish Physiotherapist As-
sociation’s membership register, it can be assumed that
the results are nationally representative.
It is worth discussing, if ethical competence can in its
wholeness be measured objectively in physiotherapy or
generally in health care, using quantitative measures.
However, the way physiotherapists evaluate their ethical
competence is important as this would likely affect
whether they see a need to pay attention to their ethical
decisions or educate themselves in ethical issues, even
when it does not tell about physiotherapists’ actual cap-
acity to act ethically in a given situation. This article de-
scribes the implementation of a novel self-evaluation
instrument to measure ethical competence from a phys-
iotherapist’s viewpoint, leaving the patient’s point of
view and experiences still incomplete. This needs further
consideration.
Conclusion
This study was the first attempt to evaluate ethical com-
petence in this extent in the context of physiotherapy.
The ultimate goal was to enhance physiotherapists’ eth-
ical knowledge and awareness of moral issues and illus-
trate the role of ethics in physiotherapy to improve the
ethical quality of physiotherapy care. Constructing an in-
strument to be able to self-evaluate these aspects in
physiotherapy situations has been a step towards this
goal. Physiotherapists consider themselves quite compe-
tent in ethics, even if they are not very familiar with eth-
ical codes or methods for ethical problem-solving. The
competence to recognize ethical issues in a situation,
ethical awareness, needs further exploration, as almost
one third of the respondents report they have not en-
countered ethical challenges in their practice. Both
quantitative and qualitative data should be collected to
consider the patients’ viewpoint about ethically
competent care, to better ensure the ethical safety of the
patient. Also, the exploration of the structure of the
PECET using confirmatory factor analysis, and Rasch
analysis for the item level assessment should be con-
ducted in the future.
ETENE: The national advisory board on social welfare and health care ethics;
FAP: Finnish association for physiotherapists; PECET : Physiotherapist’s ethical
competence evaluation tool; SD: Standard deviation; WCPT: World
confederation for physical therapy
The authors would like to thank the physiotherapists who spent time
answering the questionnaire and reflecting on the aspect of ethical
competence in physiotherapy practice. The authors would also like to thank
the Finnish Association of Physiotherapists of a grant received.
KK, RS and HL-K have made contributions to the conception and design of
the work. PP has made contributions to the analysis of the data. KK was a
major contributor in writing the manuscript. AT, RS and HL-K have revised
the work. All authors read and approved the final manuscript.
For the statistical support a grant was received from the Finnish Association
of Physiotherapists. The FAP’s membership register was used for data
collection.
The datasets used and/or analyzed during the current study are available
from the corresponding author on reasonable request.
The Ethics Committee for Human Sciences at the University of Turku
(reference number 30/2014) approved this study. The respondents were
informed that the completion of the survey is an indication of consent to
participate the study. The use of implied consent was clarified in the
application and approved by the Ethics Committee.
Not applicable.
The authors declare that they have no competing interests.
1Department of Nursing Science, University of Turku, FI-20014 Turku, Finland.
2Department of Nursing Science/ Turku University Hospital and City of Turku,
Welfare Division, University of Turku, Turku, Finland. 3National Institute for
Health and Welfare, Turku, Finland. 4Department of Nursing Science, Turku
University Hospital, University of Turku, Turku, Finland.
Received: 9 September 2019 Accepted: 1 April 2020
1. World Health Organization. Global Health Ethics. Key issues. Global Network
of WHO Collaborating Centres for Bioethics. 2015. https://apps.who.int/iris/
bitstream/handle/10665/164576/9789240694033_eng ;jsessionid=64A2
AA9570B423D1989F33D18E33A827?sequence=1. Accessed 16 Aug 2019.
2. Paganini MC, Egry EY. The ethical component of professional competence
in nursing: An analysis. Nurs Ethics. 2011;18:571–82.
3. Hudon A, Drolet M-J, Williams-Jones B. Ethical Issues Raised by Private
Practice Physiotherapy Are More Diverse than First Meets the Eye:
Recommendations from a Literature Review. Physiother Can. 2015;67:124–32.
4. Stolt M, Leino-Kilpi H, Ruokonen M, Repo H, Suhonen R. Ethics interventions
for healthcare professionals and students: A systematic review. Nurs Ethics.
2018;25:133–52.
KULJU et al. BMC Medical Ethics (2020) 21:43 Page 10 of 11
https://apps.who.int/iris/bitstream/handle/10665/164576/9789240694033_eng ;jsessionid=64A2AA9570B423D1989F33D18E33A827?sequence=1
https://apps.who.int/iris/bitstream/handle/10665/164576/9789240694033_eng ;jsessionid=64A2AA9570B423D1989F33D18E33A827?sequence=1
https://apps.who.int/iris/bitstream/handle/10665/164576/9789240694033_eng ;jsessionid=64A2AA9570B423D1989F33D18E33A827?sequence=1
5. Höglund AT, Eriksson S, Helgesson G. The role of guidelines in ethical
competence-building: perceptions among research nurses and physicians.
Clin Ethics. 2010;5:95–102.
6. Eriksson S, Helgesson G, Höglund AT. Being, doing and knowing:
Developing ethical competence in health care. J Acad Ethics. 2007;5:207–16.
7. Kulju K, Stolt M, Suhonen R, Leino-Kilpi H. Ethical competence: Concept
analysis. Nurs Ethics. 2016;23:401–12.
8. Lechasseur K, Caux C, Dollé S, Legault A. Ethical competence – An
integrative review. Nurs Ethics. 2018;25:694–706.
9. Nalette E. Constrained physical therapist practice: an ethical case analysis of
recommending discharge placement from the acute care setting. Phys Ther.
2010;90:939–52.
10. Kulju K, Suhonen R, Leino-Kilpi H. Ethical problems and moral sensitivity in
physiotherapy: A descriptive study. Nurs Ethics. 2013;20:568–77.
11. Poulis I. Bioethics and physiotherapy. J Med Ethics. 2007;33:435–6.
12. Praestegaard J, Gard G. Ethical issues in physiotherapy – Reflected from the
perspective of physiotherapists in private practice. Physiother Theory Pract.
2013;29:96–112.
13. Laliberté M, Jones BW, Feldman DE, Hunt M. Ethical Challenges for Patient
Access to Physical Therapy : Views of Staff Members from Three Publicly –
Funded Outpatient Physical Therapy Departments. Narrat Inq Bioeth. 2017;
7(2):157–69.
14. Delany C. The role of clinical ethics consultations for physical therapy
practice. Phys Ther Rev. 2012;17:176–83.
15. Delany C, Edwards I, Fryer C. How physiotherapists perceive, interpret, and
respond to the ethical dimensions of practice: A qualitative study.
Physiother Theory Pract [In press]. 2018. https://doi.org/10.1080/09593985.
2018.1456583.
16. European Commission: Explaining the European Qualifications Framework
for lifelong learning. 2008. https://ec.europa.eu/ploteus/sites/eac-eqf/files/
brochexp_en . Accessed 26 Aug 2019.
17. World Health Organization: WHO Global Competency Model. 2012. http://
www.who.int/employment/WHO_competencies_EN . Accessed 24 Aug
2019.
18. Holopainen R, Piirainen A, Heinonen A, Karppinen J, O’Sullivan P. From
“Non-encounters” to autonomic agency. Conceptions of patients with low
back pain about their encounters in the health care system. Musculoskeletal
Care. 2018;16:1–9.
19. Sjögren T, von Hedenberg L, Parikka E, Valkeinen H, Heikkinen A, Piirainen A.
The core competences of Finnish physiotherapists in the light of research
data. In: Paper presented at: The 4th European Congress of the ER-WCPT /
Physiotherapy 102S; 2016. p. eS1–eS42.
20. Dierckx de Casterle B, Izumi S, Godfrey NS, Denhaerynck K. Nurses’
responses to ethical dilemmas in nursing practice: meta-analysis. J Adv Nurs.
2008;68:540–9.
21. Poikkeus T, Numminen O, Suhonen R, Leino-Kilpi H. A mixed-method
systematic review: support for ethical competence of nurses. J Adv Nurs.
2014;70:256–71.
22. Aguilar-Rodriquez M, Marques-Sule E, Serra-Añó P, Espí-López GV, Dueñas-
Moscardó L, Pérez-Alenda S. A blended-learning programme regarding
professional ethics in physiotherapy studentsNurs Ethics [In press]. 2018.
https://doi.org/10.1177/0969733017748479.
23. Hooper C. Ethics virtual patients: a new pedagogical tool for educators? J
Med Ethics. 2015;41:549–52.
24. Cannaerts N, Gastmans C, Dierckx de Casterle B. Contribution of ethics
education to the ethical competence of nursing students: Educators’ and
students’ perceptions. Nurs Ethics. 2014;21:861–78.
25. World Health Organization: Transforming and scaling up health
professionals’ education and training. 2013. https://apps.who.int/iris/
bitstream/10665/93635/1/9789241506502_eng . Accessed 24 Aug 2019.
26. World Confederation for Physical Therapy: Ethical principles. 2015. http://
www.wcpt.org/policy/ps-ethical-responsibilities. Accessed 3 Aug 2019.
27. Finnish Association of Physiotherapists (FAP): Ethical guidelines for
physiotherapists. 2014. https://www.suomenfysioterapeutit.fi/wp-content/
uploads/2018/01/Ethical_Guidelines_2014 . Accessed 3 Aug 2019.
28. Praestegaard J, Gard G. The perceptions of danish physiotherapists on the
ethical issues related to the physiotherapist-patient relationship during the
first session: a phenomenological approach. BMC Med Ethics. 2011;12:21.
29. Drolet M-J, Hudon A. Theoretical frameworks used to discuss ethical issues
in private physiotherapy practice and proposal of a new ethical tool. Med
Health Care Philos. 2015;18:51–62.
30. Reader TW, Gillespie A, Mannell J. Patient neglect in 21st century health-
care institutions: A community health psychology perspective. J Health
Psychol. 2014;19:137–48.
31. Koskenniemi J, Leino-Kilpi H, Suhonen R. Manifestation of respect in the
care of older patients in long-term care settings. Scand J Caring Sci. 2015;
29:288–96.
32. Bernhardsson S, Johansson MEH, Larsson K, Öhberg B. “In the physio we
trust”: A qualitative study on patients’ preferences for physiotherapy.
Physiother Theory Pract. 2017;33:535–49.
33. Carpenter C. Moral distress in physical therapy practice. Physiother Theory
Pract. 2010;26:69–78.
34. Kävlemark Sporrong S, Arnetz B, Hansson MG, Westerholm P, Höglund AT.
Developing ethical competence in health care organisations. Nurs Ethics.
2007;14:825–37.
35. Sharma R, Jain A, Gupta N, Garg S, Batta M, Kant DS. Impact of self-
assessment by students on their learning. Int J App Basic Med Res. 2016;6:
226–9.
36. Koskenvuori J, Stolt M, Suhonen R, Leino-Kilpi H. Healthcare professionals’
ethical competence: A scoping review. Nurs Open. 2019;6:5–17.
37. Naudé A, Bornman J. A Measuring Instrument for Ethical Sensitivity in the
Therapeutic Sciences. J Clin Ethics. 2017;28:290–302.
38. Swisher LL. Moral reasoning among physical therapists: results of the
Defining Issues Test. Physiother Res Int. 2010;5:69–79.
39. DeVellis RF. Scale Development: Theory and Applications. 4th ed. SAGE:
Thousand Oaks, California; 2017.
40. Cronbach L. Coefficient alpha and the internal structure of tests.
Psychomerika. 1951;16:297–34.
41. Finlex. The Act on the Status and Rights of Patients (No. 785/1992). 1992.
https://www.finlex.fi/en/laki/kaannokset/1992/en19920785. Accessed Jun
2019.
42. Finlex. Personal Data Act (No. 523/1999). 1999. https://www.finlex.fi/en/laki/
kaannokset/1999/19990523. Accessed Jun 2019.
43. ETENE The National Advisory Board on Social Welfare and Health Care
Ethics: Shared values in health care, common goals and principles:
Principles of Health Care Ethics. 2001. https://etene.fi/documents/142
9646/1571616/Publication+3+Shared+values+in+Health+Care%2C+
Common+Goals+and+Principles%2C+2001 /10bdd2be-c322-48c2-a143-4
e11ebc9235f/Publication+3+Shared+values+in+Health+Care%2C+
Common+Goals+and+Principles%2C+2001 . Accessed 12 Aug 2019.
Springer Nature remains neutral with regard to jurisdictional claims in
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https://doi.org/10.1080/09593985.2018.1456583
https://doi.org/10.1080/09593985.2018.1456583
https://ec.europa.eu/ploteus/sites/eac-eqf/files/brochexp_en
https://ec.europa.eu/ploteus/sites/eac-eqf/files/brochexp_en
http://www.who.int/employment/WHO_competencies_EN
http://www.who.int/employment/WHO_competencies_EN
https://doi.org/10.1177/0969733017748479
https://apps.who.int/iris/bitstream/10665/93635/1/9789241506502_eng
https://apps.who.int/iris/bitstream/10665/93635/1/9789241506502_eng
http://www.wcpt.org/policy/ps-ethical-responsibilities
http://www.wcpt.org/policy/ps-ethical-responsibilities
https://www.suomenfysioterapeutit.fi/wp-content/uploads/2018/01/Ethical_Guidelines_2014
https://www.suomenfysioterapeutit.fi/wp-content/uploads/2018/01/Ethical_Guidelines_2014
https://www.finlex.fi/en/laki/kaannokset/1992/en19920785
https://www.finlex.fi/en/laki/kaannokset/1999/19990523
https://www.finlex.fi/en/laki/kaannokset/1999/19990523
https://etene.fi/documents/1429646/1571616/Publication+3+Shared+values+in+Health+Care%2C+Common+Goals+and+Principles%2C+2001 /10bdd2be-c322-48c2-a143-4e11ebc9235f/Publication+3+Shared+values+in+Health+Care%2C+Common+Goals+and+Principles%2C+2001
https://etene.fi/documents/1429646/1571616/Publication+3+Shared+values+in+Health+Care%2C+Common+Goals+and+Principles%2C+2001 /10bdd2be-c322-48c2-a143-4e11ebc9235f/Publication+3+Shared+values+in+Health+Care%2C+Common+Goals+and+Principles%2C+2001
https://etene.fi/documents/1429646/1571616/Publication+3+Shared+values+in+Health+Care%2C+Common+Goals+and+Principles%2C+2001 /10bdd2be-c322-48c2-a143-4e11ebc9235f/Publication+3+Shared+values+in+Health+Care%2C+Common+Goals+and+Principles%2C+2001
https://etene.fi/documents/1429646/1571616/Publication+3+Shared+values+in+Health+Care%2C+Common+Goals+and+Principles%2C+2001 /10bdd2be-c322-48c2-a143-4e11ebc9235f/Publication+3+Shared+values+in+Health+Care%2C+Common+Goals+and+Principles%2C+2001
https://etene.fi/documents/1429646/1571616/Publication+3+Shared+values+in+Health+Care%2C+Common+Goals+and+Principles%2C+2001 /10bdd2be-c322-48c2-a143-4e11ebc9235f/Publication+3+Shared+values+in+Health+Care%2C+Common+Goals+and+Principles%2C+2001
- Abstract
Background
Method
Results
Conclusions
Background
The aim of the study
Methods
Survey instrument
Data analysis
Ethical considerations
Results
Respondent characteristics
Self-evaluation of ethical competence
Discussion
Strengths and limitations
Conclusion
Abbreviations
Acknowledgements
Authors’ contributions
Funding
Availability of data and materials
Ethics approval and consent to participate
Consent for publication
Competing interests
Author details
References
Publisher’s Note
Of Beltways, Runways, and Sight
Lines: Perspectives, Challenges,
and Futures of ATS “Global
Awareness and Engagement”
Lester Edwin J. Ruiz
The Association of Theological Schools
ABSTRACT: Providing a century of context for the ATS commitment to
global awareness and engagement, the author outlines briefly how that com-
mitment has evolved, with a growing recognition of the changing character of
“globalization״ and, in that context, the need for diversity, mutuality, respect;
and equity among all partners. The article goes on to cite complex dilem-
mas and challenges that effective global partnerships must address: defining
ministry for a globalizing world, navigating politics and institutional com-
mitments, and adjusting approaches to pedagogy, delivery, programs, and
accreditation. His contention is that the ultimate success of global engage-
ment will rest not only on programming but also on a shared understanding
about and practice of partnerships and relationships.
We recommend that this Conference assure the [Inter- national Missionary] Council of our genuine interest
in theological education in all lands; that we express our
conviction that the educational problems of any particular
land must be met primarily from within that land; that we
express our readiness to share in any possible and desired
way in the meeting of these problems; and that we call
attention to significant cooperative undertakings already
carried out, such as the Deputation of the American
Church History Society . . . the study of Christian educa-
tion in India … and the approaching study of theological
education in China.1
… a text is made of multiple writings, drawn from many
cultures and entering into mutual relations of dialogue,
1 ATS Bulletin 9, “Biennial Minutes, The Ninth Biennial Meeting of the Conference of
Theological Seminaries and Colleges in the United States and Canada,” June 12-13,1934,
15.
119Theological Education, Volume 52, Number 1 (2018): 119-
149
Of Beltways, Runways, and Sight Lines
parody, contestation, but there is one place where this
multiplicity is focused, and that place is the reader, not,
as was hitherto said, the author. The reader is the space
on which all the quotations that make up a writing are
inscribed without any of them being lost; a text’s unity lies
not in its origin but in its destination.2
From “globalization” to “global awareness and
engagement”3
Globalization, or what The Association of Theological Schools (ATS) Com-
mission on Accrediting Standards currently calls “global awareness and
engagement” (Commission Standard 3, section 3.3.4), has been a central
concern of ATS at least since the 1990s, although one can argue that these
concerns reach as far back as 1967, with the reflections of Harvey Cox
on “world dialogue for theological education” in the journal Theological
Education.4
The terminological move from “globalization” to “global aware-
ness and engagement”—at least as a normative description of that part of
the work of theological education that acknowledges that North American
theological education is not (or ought not to be) the center of the theologi-
cal education universe—was not made lightly, and marks a critical move
within ATS. Those familiar with the dynamics of ATS as a membership
organization know that by the time a normative statement is adopted
(or revised) as part of its Standards of Accreditation, a long, somewhat
complex, iterative process already would have been travelled by ATS
2 Roland Barthes, Image-Music-Text (New York: Hill and Wang, 1977),
142
–
148
.
3 Part of the reason, perhaps more implicit than explicit, for the Association’s
move from “globalization” to “global awareness and engagement” has to do with an
acknowledgement of the need for a working definition of “globalization” that is (1)
broader in reach, perhaps intentionally metaphoric; (2) more hospitable of the diversi-
ties of global experiences, institutional priorities, and missional commitments of ATS
member schools; and (3) more capable of accommodating and “holding together” both
the legacies of tradition and innovation and continuities and changes of accredited
graduate theological education in terms of its being decidedly normative, thoroughly
performative, and intentionally formative.
4 Harvey Cox, “The Significance of the Church—World Dialogue for Theological
Education,” Theological Education 3, no. 2 (Winter 1967).
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Lester Edwin J. Ruiz
member schools, including a formal two-thirds, “super majority” vote on
the Standards of Accreditation themselves.
While there are multiple reasons for this terminological shift, one
reading of the ATS conversations, perhaps the dominant one, is related
to the pervasive skepticism about the appropriateness or adequacy of
the term “globalization” (and its consequences for theological educa-
tion) given its co-optation by (neoliberal) economic—even political (read
“western hegemonic”)—globalization to characterize the normative vision
of ATS in this area of theological education. Another reading of this shift
is tied to the recognition that there are multiple meanings and emphases
of “globalization” among ATS member schools—often deeply contested,
sometimes almost incommensurable—hence the need for “less ideo-
logical,” or polarizing signifiers that would allow for a more inclusive
organizational embrace of diversity in this area of work. A third reading
of this shift is rooted in assumptions about the nature of human reality
and language itself where human experience, because of its densities, is
not always amenable to or exhausted by what Paul Ricoeur called the
“moment of explanation” within the larger interpretive framework of
explanation, understanding, and appropriation that the nature of human
reality demands because of these assumed densities.
There are rich traditions, perspectives, resources, and practices on
globalization within the Association, the significance of some still waiting
to be rediscovered, further developed, or critically revisited.5 Formal ATS
5 Even the most cursory review of the issues of Theological Education will reveal the
depth and breadth of this tradition. See for example: volume 9, no. 4 (Summer 1973);
volume 21, no. 1 (Autumn 1984); volume 22, no. 2 (Spring 1986); volume 26, supplement
1 (Spring 1990); volume 27, no. 1 (Autumn 1990); volume 27, no. 2 (Spring 1991); volume
29, no. 2 (Spring 1993); volume 30, no. 1 (Autumn 1993); volume 35, no. 2 (Spring 1999).
Of direct relevance for this discussion, perhaps, are: ״Incarnating Globalization in ATS
Schools: Issues, Experiences, Understandings, Challenge,״ volume 35, no. 2 (Spring
;(volume 26, supplement 1 (Spring 1990 ״Fundamental Issues in Globalization״ ;(1999
and ״Patterns of Globalization: Six Studies,״ volume 27, no. 2 (Spring 1991). One piece
of historical trivia suggests how far back in the history of ATS globalization reaches:
-At a meeting of the Continuation Committee, June 3,1919,” the minutes of the Com״
mittee records, ״a subcommittee was appointed to procure data relating to theological
schools, courses of study, conditions of admission, etc., in England, Scotland, France,
Switzerland, and Flolland for the information of students of the United States and
Canada who desire to continue their studies in the countries named …” Conference
of Theological Seminaries of the United States and Canada, Minutes of Continuation
Committee, ATS Bulletin 2, December 1921.
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programming in the past ten years, at least, has not only built on these
resources but has moved ATS discourse toward even more critical and ere-
ative directions that have contributed to the deepening and broadening
of diversity, mutuality, and equity—core values that have animated not
only this long tradition of “global awareness and engagement” in accred-
ited graduate theological education in general and within the Association
itself, in particular, but also in the larger life and work of the Association’s
member schools.
Three historical developments are worth mentioning at the outset
because they pose significant framing implications for the question of
“global awareness and engagement”: (1) the demographic shifts signaled
by the cipher “2040,” (2) the shifting “center” of Christianity from the
Global North to the Global South, and (3) the rapid growth of immigrant
churches in North America in the last 20 years. ATS has programmatically
attended to the first development for some time now (e.g., through the
programmatic work of its Committee on Race and Ethnicity). And while
it has addressed the second two on occasion or indirectly (e.g., the racial/
ethnic, constituency-based conferences in the early 2000s), these areas
remain largely unaddressed, leading some racial/ethnic constituencies
who were involved in these events to note that “ATS has abandoned us.”
These three historical developments are not only raising even more clearly
the question of “global awareness and engagement,” but they also hold
the possibility of decisively shaping the future of ATS itself.
For many ATS member schools, “global awareness and engagement”
is framed largely, though not exclusively, by a concern about how best to
understand the relationship—broadly conceived—between their particular
locations as institutions in the United States and Canada and the rest of the
world. Such awareness and engagement is built directly into the histories,
missions, and ethos of their institutions—because of either the worldwide
character of the ecclesial family to which they belong, their missionary or
evangelistic orientations, or their geographical locations and the natures
and compositions of their faculty and/or student bodies, and the commu-
nities to which they declare both affinities and accountabilities.
More recent ATS surveys that are part of its Educational Models and
Practices in Theological Education project strongly suggest a growing
engagement of schools in transnational, transborder, and transcultural
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Lester Edwin /. Ruiz
theological education.6 Many schools have collaborative degree programs
with partner institutions in the “majority world” at the certificate, bacca-
laureate, post-baccalaureate, and post-master’s levels—some in extension
education, distance-learning, or “global-consortiums” formats. Others
have faculty exchanges involving short-term teaching and/or research.
Still others have both credit- and noncredit-bearing intercultural and con-
textual programs (e.g., travel seminars, immersion and contextualization
programs, and “missionary” initiatives). Others also have partnerships
with their historic communities of origin—whether global-global, global-
south, or south-south.
Some schools have established centers directly related to global aware-
ness and engagement (e.g., Trinity Evangelical Divinity School’s Center
for World Christianity and Global Theology, Ambrose Seminary’s Jaffray
Centre for Global Initiatives, and New York Theological Seminary’s Center
for World Christianity). Certain schools offer Spanish- or Mandarin-
language courses, while others have Korean-language degree programs.
Some ATS schools have extension sites in Germany, the Ukraine, Indone-
sia, Guatemala, and Thailand.
While not always uniformly articulated, member schools—in addition
to their missional and theological convictions regarding global aware-
ness and engagement—have a wide range of rationales for their programs
and initiatives. These include (1) a recognition that quality theological
education in North America, including its relevance, must not only have
an external “global reach” but must also integrate non-North American
theological resources as constitutive of its North American identity; (2) a
realization that sustainable quality education should be a globally shared
enterprise whose survival is inextricably linked to this “global” reciproc-
ity in the production and reproduction of theological knowledge, wisdom,
and practice; (3) an affirmation that the educational purpose of a “good
theological school” or “good theological education” is to prepare students
to be “global citizens” who have the appropriate competencies, capad-
ties, and sensibilities adequate to a fast-changing interdependent and
globalizing world; and (4) a conviction that any theological education that
6 See Deborah H. C. Gin, “Four points to consider for international partnerships,”
Colloquy Online, February 2018, https://www.ats.edu/uploads/resources/publications־
presentations/colloquy-online/four־points־to־consider־for־intemational־partnerships.
pdf.
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deserves to be called “good” must be able to embrace, if not navigate, the
difficult but necessary intersectionalities of “the global” and “the local.”
In the past five years, due in part to an increasing, if not re-awakened,
interest in ATS outside North America, and also to the “globalization of
theological education” in a shrinking world,7 ATS staff and other ATS-
related individuals have been involved in transborder, transdisciplinary,
transorganizational conversations, resource sharing, and cooperative pro-
gramming with such international organizations as the Asia Theological
Association (ATA), the Association for Theological Education in Southeast
Asia (ATESEA), the Foundation for Theological Education in Southeast
Asia (FTESEA), the International Council on Evangelical Theological
Education (ICETE), the Lausanne Movement, the World Conference of
Associations of Theological Institutions (WOCATI), and the World Council
of Churches’ Ecumenical Theological Education (ETE).
These international organizations and others like them are important
partners who rightly perceive that ATS may have much to offer them. In
return, no doubt, individual ATS member schools as well as the Associa-
tion as a whole, have much to learn from theological education outside
North American boundaries. Recognizing this growing rediscovery of
mutual, reciprocal need, the ATS Board of Directors began to revisit, at
least since 2009, the idea and practice of “globalization,” engaging in more
structured conversations regarding the subject, first in terms of the notion
of “ATS as a ‘big’ tent” and more recently in terms of the framework of
“ATS and world Christianity.”
Inside the “big tent” ecumenical beltway: institutional,
organizational, and programmatic issues
Where the former is concerned, the working group convened by the ATS
Board of Directors to explore the subject and review the practice of “big
tent ecumenicity,” after several meetings by conference call culminât-
ing in its November 2012 board meeting, decided to pursue the notion
7 Dietrich Werner, David Esterline, Namsoon Kang, and Joshva Raja, eds., Handbook
of Theological Education in World Christianity: Theological Perpsectives, Ecumenical Trends,
Regional Surveys (Oxford, England: Regnum Books International, 2010). World Con-
ference of Associations of Theological Institutions, Challenges and Promises of Quality
Assurance in Theological Education: Multicontextual and Ecumenical Inquiries (Fort Worth,
Texas: WOCATI, 2013).
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Lester Edwin J. Ruiz
of “big tent ecumenicity” largely within a programmatic rather than an
administrative/organizational framework, where “big tent” meant the
larger Jewish-Christian tradition. It was agreed that, while the Association
may have reached a level of maturity that allows for robust conversa-
tions on theological diversity among its membership, the administrative/
organizational conditions were not congenial at that time for pursuing
the question of diversity across religious and multifaith lines. While some
member schools understand their institutional identities in terms of an
interreligious perspective (e.g., Claremont School of Theology, Harvard
University Divinity School, University of Chicago Divinity School, Hart-
ford Seminary, and Graduate Theological Union), most member schools
continue to understand their missions within a North American Jewish-
Christian perspective, notwithstanding their recognition of the importance
of addressing interreligious and multifaith issues.8 World Christianity,
rather than world religions, was affirmed as the primary organizing meta-
phor for “big tent ecumenicity.” That said, the question of interreligious,
multifaith ecumenicity will not go away; and the conversation cannot be
postponed indefinitely.
Thus, in its meetings during this period, the board agreed to more
fully explore the implications of “world Christianity” for the future of
ATS—of which focused reflection on the meaning and significance of
transdisciplinary, transborder, and transorganizational perspectives and
practices was a logical “next step.” In fact, while racial/ethnic and gender
diversity under the sign of multiculturalism had its own specific origins in
ATS discourse apart from the discourse on “globalization,” their co-con-
stitutive character vis-à-vis global awareness and engagement has come
to be recognized more fully so that the need to deal explicitly with the
latter has come to the fore once again, this time within a multicultural,
multireligious framework. These steps included an affirmation of the
need to pursue more systematically at least two substantive and program-
mafic questions: (1) What should ATS be doing with its member schools in
8 One way to read Dan Aleshire’s “Community and Diversity” plenary address at
the 2012 Minneapolis Biennial Meeting is as a cipher of the Association’s readiness
to explicitly address the fundamental importance of theological/ecclesial diversity,
in addition to the more conventionally-accepted racial/ethnic, gender, and missional
diversities long recognized by the Association, for the meaning of “big tent” ecu-
menicity. See https://www.ats.edu/uploads/resources/publications-presentations/
documents/communi ty-and-diversity .
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terms of the question of ATS involvement outside North America? and (2)
What should ATS be doing with its “partners” (e.g., ATESE A, ATA, ICETE,
WOCATI, etc.) outside North America? The first question fixes its gaze
internally; the second question gazes externally. Both are important to how
ATS, as an organization, understands global awareness and engagement
and are decisive not only to the programmatic direction that ATS should
take but also, perhaps more importantly, to the future of ATS either as
a binational organization that prefers to remain so, or as an organiza־
tion that seeks to engage the world globally in the service of accredited
graduate theological education. Needless to say, a substantive bifurcation
of these questions would be ill-advised; and a programmatic bifurcation
would most probably prove to be perilously nearsighted.
In December 2013, the ATS Board of Directors adopted a framework
statement to both authorize and guide future ATS work related to global
awareness and engagement in six sufficiently discrete, though fundamen-
tally interconnected, major areas: (1) understanding effective partnerships,
(2) global engagement within North America, (3) cultivating scholarly and
programmatic “trade routes,” (4) contributing to a pan-Christian conver-
sation on theological education, (5) educational and degree programs of
study, and (6) continuing research and care. The statement also under-
scored the guiding principle that current and future ATS involvement in
programs with a “global reach” must include constituencies and publics
that involve mainline, evangelical, and Roman Catholic/Orthodox indi-
viduals and groups—a practice for which ATS is known in its work with
member schools.9
As if to both pre-figure and embody this landmark framework state-
ment, in the fall of 2012, a small group of individuals representing some
of the ATS mainline member schools and international partners (ATESEA
and WCC) met in Pittsburgh to discuss the present and future shape of
theological education as well as the need for developing systematic and
intentional partnerships beyond North America in the service of good
theological education. Similarly, in late spring 2013, a small group of
presidents and deans representing some of the ATS evangelical member
9 Guidelines on Global Awareness and Engagement from ATS Board of Directors,
https://www.ats.edu/uploads/accrediting/documents/guidelines־on־global־aware־
ness־and־engagement־from־ats־board%20%282013%29 , accessed October 15,2017.
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Lester Edwin J. Ruiz
schools and organizations (e.g., the Overseas Council) met by conference
call also to address the same questions that were discussed in the fall 2012
consultation of mainline schools. In January 2015, Roman Catholic rectors
and presidents met to discuss similar issues in a consultation in Chicago,
hosted by Catholic Theological Union. In June 2015 in Pittsburgh, ATS con-
vened representatives of member schools engaged in global partnership
programs of one kind or another to explore further the meaning and sig-
nificance of those partnerships for theological education. Finally, in May
2016, ATS coordinated the first meeting of the Global Forum of Theological
Educators (GFTE) in Dorfweil, Germany, gathering, possibly for the first
time ever in one united forum, approximately 80 theological educators
from 35 countries from six major church confessional families—Orthodox,
Roman Catholic, Protestant, Evangelical, Pentecostal, and Independent
churches—to learn from one another and to share about the current situa־
tion of theological education and ministerial formation on a global scale in
the context primarily of fellowship.10 Finally, ATS staff participated in the
historic consultation of ICETE accreditation agencies in Rome in fall 2017,
the purpose of which was to develop a structure and process “whereby
common accreditation standards and benchmarks [can] be developed
within the ICETE network among accreditation agencies in consultation
with the church.”11
In addition, for the ATS Educational Models and Practices in Theo־
logical Education (EMPTE) project, two working groups on “global
partnerships” drawn from ATS member schools explored, among other
things, not only what “global partnerships” might look like under the con-
ditions of diversity, mutuality, and equity, but also how these partnerships
10 These meetings were made possible through existing ATS undesignated funds
and a 2014 planning grant from the Henry Luce Foundation.
11 ICETE,Rome Benchmarks,https://www.facebook.com/groups/1241553362592175/,
accessed October 15, 2017.
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can be enacted where unevenness (political, economic, and administra-
ti ve) is a dominant reality.12
These ATS staff-supported initiatives may be interpreted not only as a
response to the ongoing commitments of ATS noted above but also as part
of the goal of enlisting individuals and groups both within and without
North America, assuming a framework of collaboration and shared
wisdom, to help ATS as an organization to formally and substantively
define its role “in the world.” In this regard, the WOCATI example is illus-
trative of an important institutional initiative in which ATS was involved.
In the 1990s, with ATS support, accrediting agencies around the world
were brought together for “fellowship, academic research, and mutual
support.”13 Unfortunately, for reasons larger than the limited support pro-
vided by ATS, WOCATI was not able to build a sustainable institutional
infrastructure on which the continuity of the organization needed to rest.
12 As part of the Educational Models and Practices in Theological Education Project,
two focused groups on ״global partnerships,” consisting of 12 schools, met to explore
the different issues, questions, and challenges that cluster around the notion of “global
partnerships.” One group explored matters related to issues of reciprocity, spiritual
formation (study abroad/immersion), and international accreditation. This group
identified best practices for initiating, practicing, sustaining, and concluding global
partnerships. The group identified a number of educational principles, including, but
not limited to, excellence both institutional and educational, diversity and mutual-
ity, experiential and group learning, interreligious faith dialogue, and integrity and
accountability. The other group, identified crucial issues that, in their shared expe-
rience, arise when considering, initiating, and sustaining global partnerships. This
included faculty ownership of the globalization processes in their respective institu-
fions, the need to establish coherence in articulating degrees offered in different global
contexts, and the need to investigate the philosophical and theological mindset behind
global partnerships. The group also identified challenges and opportunities in global
partnerships, including issues of institutional and educational effectiveness, financial
viability, and attentiveness to educational principles. See The ATS Educational Models
and Practices in Theological Education Project, “Educational Models and Practices
Peer Group Final Reports,” https://www.ats.edu/uploads/resources/current-initia־
tives/educational-models/publications-and-presentations/peer-group-final-reports/
peer-group-final-report-book , accessed April 16, 2018.
13 “WOCATI’s greatest service to American theological education,” Glenn T. Miller
writes, “may lie in the future. American religion, especially Mainstream Protestantism,
is changing rapidly, and these changes may require substantial changes in how the
United States educates its ministers . . . Just as America provided much of the world
with the model of the graduate theological seminary, so the rest of the world may
provide American Christians with fresh understandings and strategies of how to train
their ministers.” Glenn T. Miller, Piety and Plurality: Theological Education Since 1960
(Eugene, Oregon: Cascade Books, 2014), 297.
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Lester Edwin J. Ruiz
The WOCATI experience raised large strategic questions for ATS that
presupposed even broader substantive, not to mention political, questions,
including the following:
• If ATS were to be involved outside North America, what should that
involvement look like: immersion? solidarity? missionary? contextual?
dialogical? bilateral? multilateral?14 Who should be involved, and with
whom?
• What are the dilemmas posed by such an involvement, and how may
they best be addressed? For example, it seems clear that involvements
at any of these levels (dependence, interdependence, independence)
are welcomed by some and rejected by others? Put somewhat differ-
ently, what are the consequences of such involvement?15
• If “being involved” or “being available” are appropriate stances, how
does ATS structure institutionally such “availability” that avoids past
mistakes, while rejecting the easy response of “non-involvement/
non-interference”? What would this “availability” cost in terms of per-
sonnel, financial, and other resources?
These difficult questions notwithstanding, the experience of collabora-
tion globally affirmed the “convening capacity” of ATS, based not only on
its long history as a membership organization but also on the basis of its
commitment to “big tent” inclusivity in terms of both its program and its
accreditation functions. And while ATS may be more known intemation-
ally for its expertise as an accrediting body, it has the capacity to convene
and to extend the binational reach of its programs and services to a more
multilateral, if not more global, level and to serve as yet another contribu-
tion to the vitality of “world Christianity.” For example, ATS programs
14 Some of the images of involvement shared by consultation participants included
ATS as both ״host and guest” (hospitality), resource or broker, companion (accompani-
ment), or dialogue partner.
15 For example, if the Commission were to extend its scope of accreditation to schools
outside North America, as some regional accreditors have, this could create a tiered
structure of theological education in other parts of the world based on some kind of
“favored status” achieved by schools that would be recognized by the USDE by virtue
of ATS accreditation. Members of the ATS Board of Directors have advised caution, as
part of its commitment to an ethics of “global awareness and engagement,” if ATS or
the Commission were to move in this direction.
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Of Beltways, Runways, and Sight Lines
for presidents, deans, CFOs, development officers, and student services
personnel might be made available to interested institutions outside
North America while also introducing a more “global” content (e.g., the
consequences of the presence of visa students in ATS member schools for
theological education in North America) to benefit North American theo-
logical educators. ATS could also serve, as it has in the past, as a resource
“broker” for its international partners, recommending or connecting
individuals and organizations with ATS-related program or accreditation-
related expertise.
Various consultation participants also acknowledged that many of the
programs of ATS member schools—whether educational, denominational,
or missional—already have some kind of global reach. And while there
is no pressing need for ATS to provide a coordinating function, it could
nonetheless serve as a clearing house or informational, cormectional portal
for these programs. The ATS database, for example, could be utilized to
organize information provided by member schools related to areas of
international interest, and made more available or accessible to partners
outside North America.16
Consultation participants also acknowledged that not only does the
global reach of ATS need to be deeply attentive to the diversities of mission,
theology, polity, and identity both within and without North America, but
also that its global awareness and engagement needs to be disciplined by a
commitment to mutuality, respect, and care. For example, attentiveness to
the unevenness of resources and interpretation of “good theological edu-
cation” could express itself programmatically in the principled sharing
of accreditation expertise, but without extending ATS or Commission
membership to non-US and Canadian schools. Or, such attentiveness to
16 Dan Aleshire’s plenary address at the 2013 ATESEA General Assembly in Silang,
Cavite, Philippines, as well as David Esterline’s and Lester Edwin J. Ruiz’s presen-
tâtions at the 2011 WOCATI meeting in Johannesburg, South Africa, are illustrative
of this transborder information sharing. The point, of course, is, how can ATS make
this valuable information and insight more readily available or accessible in ways
that affirm both the importance of “high touch” engagement and the need for more
sustainable, more efficient, and less labor-intensive methods of dissemination? See
Namsoon Kang, John Gichimu, et al., Challenges and Promises of Quality Assurance in
Theological Education: Multicontextual and Ecumenical Inquiries, https://www.oikoumene.
org/en/resources/documents/wcc-programmes/education-and־ecumenical־formation/
ete/wocati/challenges-and-promises-of-quality-assurance-in-theological-education,
accessed October 15, 2017.
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Lester Edwin J. Ruiz
the importance of mutuality, respect, and care could be expressed by ATS
opening its North American programs to interested theological institu-
tions outside North America while ensuring that its modes of delivery do
not violate the ecologies of “local” theological education—including the
rights of theological “self-determination.” It could also convene presidents
of ATS member schools together with the presidents of theological schools
from outside North America to discuss what partnership in a global context
might mean. In this context, it is clear that ATS programming and engage-
ment understands the constitutive necessity for diversity and mutuality,
as well as the programmatic implications of equity.
Broader dilemmas, challenges, and perspectives: the
runways of global awareness and engagement
One might wish that the Global Awareness and Engagement initiative was
only about program, planning, and policy. Happily, it is not. A number
of broader issues require attention, even as they exemplify the challenges
that theological education has always faced.
First, there are definitional and substantive challenges including,
for example, (1) how globalization and theological education are to be
understood and linked, given the contested and uneven experiences of
globalization arising out of different, if asymmetrical, institutional and
educational resources, priorities, preferences, and commitments, as well
as the fact that (western or “north Atlantic”) globalization in its multiple
expressions has both constructive and destructive effects on life more gen-
erally or that it is only one among many “globalizations” alongside, for
example, Chinese, Islamic, etc.; (2) what constitutes an adequate theology
and ministry for a globalizing world, particularly in relation to historic
faith and practice; and (3) how “effective global partnerships” should be
defined and by what measures and criteria they should be assessed.
Second, there are political and institutional push-and-pull challenges,
including (1) “brain drain” (for the Global South) vis-à-vis “brain gain”
(for the Global North); (2) the need to develop self-reliant, self-sufficient,
indigenous leadership vis-à-vis mission-driven commitments for resource
sharing in a world of declining resources; (3) strong denominational
missionary commitments vis-à-vis a recognition of the need for the affir-
mation of the non-Christian “Other”; (4) the perception of North American
power and privilege and their accompanying agenda-setting prerogatives
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vis-a-vis the ethical and moral imperative for hospitality and mutual
accountability in an asymmetrical world; and (5) the singular though not
exclusive accountability of North American theological education vis-à-vis
the rest of theological education elsewhere in the world.
Third, there are educational and pedagogical challenges including
(1) the perceived, if often assumed, normativity of English in terms of
learning, teaching, and research; (2) the very real differences between
and among cultures leading to different understandings of theology and
pedagogy, for example, the differences between oral and reading/writing
cultures, of rote and constructivist learning, and of egalitarian and authori-
tarian pedagogies; and (3) the growth of new delivery systems and models
of education and mission (including distance/online, extension, and com-
petency-based education), which are based on infrastructural asymmetries
in technology and resources, as well as the dominance of an academic and
curricular structure and culture that tend to privilege the Global North at
the expense of the Global South.
Fourth, there are programmatic challenges related to educational ini-
tiatives—whether degree-granting or not—among ATS member schools,
for example, that have international extension sites raising questions
about (1) the viability, sustainability, and desirability of such programs,
the roles of partner institutions in the implementation of these programs,
and the effects of North American-run programs on the ecology of theo-
logical education in the Global South and (2) the role of North American
educational institutions, including theological ones, in the credentialing
needs and desires of individuals and institutions outside North America,
for example, direct accreditation or assistance in the development, imple-
mentation, or improvement of their own practices of accreditation.
Effective partnerships: The religio-moral dimension of
global awareness and engagement
These challenges are illustrative of the complexity of global awareness
and engagement, and instructive for understanding the deeper, perhaps
less visible, religio-moral character of global awareness and engagement.
By definition, the religio-moral is fundamentally about “what we can and
need to do together”17 in the light of what Plato called “the good, the true,
17 Manfred Halpem, Transforming the Personal, Political, Historical and Sacred in Theory
and Practice, ed. David Abalos (Scranton, PA: University of Scranton Press, 2009).
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Lester Edwin J. Ruiz
and the beautiful.” What is notable about the work of both ATS member
schools and the Association’s own initiatives—at least in my own reading
of the situation—is the religio-moral assumptions they share. Both are
based on a belief that global awareness and engagement are fundamen-
tally about the practice of “effective partnerships”: those institutional and
educational practices that are animated by normative expectations of mutu-
ality and collegiality, shared responsibility, accountability, transparency,
and decision making between and among the partners at whatever level or
kind; that have clearly agreed upon purposes that empower and transform
those in the partnerships; and that are contextualized, sustainable, useful,
and attainable. In short, effective partnerships are an inherently norma-
tive, value-explicit human activity.
Effective partnerships further illustrate the religio-moral, especially
when they include those practices that emphasize the desirability of mul-
tilateral, multilayered, and multiperspectival strategies and voices that
(1) seriously attend to the intersectionality of the issues related to global
awareness and engagement, including issues around the dialogical, ecu-
menical, evangelistic, and justice efforts of faith-based communities
including churches; (2) broaden and deepen collaborations, particularly
in terms of inclusion, plurality, and difference; and (3) are intentionally
sensitive to the nuances and specificities of asymmetrical space, time, and
place. The religio-moral is articulated even more fully in those initiatives
that encourage interdependence and relative autonomy in Global North-
South relationships, that empower those involved in the partnership, and
that flatten power differentials that arise out of the unevenness of human,
financial, and physical resources as well as history and location. A more
intentional multidirectional flow of resources between the Global North
and the Global South, where the notion of resources is redefined in more
comprehensive terms than just human, financial, or physical, is illustrative.
Effective partnering as religio-moral practice also includes the forma-
tion of a spirituality, where formation is understood as being constituted
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by “wholeness, purpose, and community,”18 that is articulated in (1) the
enhancement and improvement of individual and institutional capad־
ties and skillsets for cross-cultural, contextual, and inter- and multifaith
competencies for institutional and educational innovation and change;
(2) the knowledge and sensitivity to and respect for economic, cultural,
and religious differences that shape theological education and practice
worldwide; (3) the development and nurture of shared ideals, values, and
principles among and between the partnering individuals and institutions;
(4) the constitutive and regulative practices of active, empathie, principled,
and humble listening, as well as translation and appropriation; and (5) the
sobering “fact” that partnerships take a long time to develop and require
trust for their full flowering. The importance of such a spirituality cannot
be underestimated because our generation is heir to an insidious, subter-
ranean spirit of indifference not only to others but to the excluded Others
that, if left unchecked, will compromise the possibility of any kind of part-
nership—if it has not done so already.
In the end, global awareness and engagement cannot be under-
stood apart from the kind of personal, professional, and institutional
18 Stanton Wortham deploys the phrase, “formative education.” See “Educat-
ing whole human beings,” http://www.ascd.org/ASCD/pdf/siteASCD/wholechild/
Stanton-Wortham-2017-WCWP , accessed April 16, 2018. Put somewhat differ-
ently, following the pathway charted by Jacques Derrida, one could argue that “global
awareness and engagement” is about a sustained meditation on what “togetherness”
means—both in terms of “death” or alterity (part of what “the religious” means)
and “togetherness” (what this essay calls “global awareness and engagement” and/
or “global partnerships.” The former is explored in Jacques Derrida, Learning to Live
Finally: The Last Interview, trans., Pascal-Anne Brault and Michael Naas (New York,
NY: Melville Publications, 2007); the latter in a lecture titled Vivre ‘ensemble’—Living
‘together/ delivered at the international conference on “Irreconcilable Differences?
Jacques Derrida and the Question of Religion,” University of California, Santa Barbara,
October 23-25, 2003, where he explores the entanglements of living together as an
obvious inevitability, on the one hand, and, on the other hand, as a promise (and
despair) occasioned by proximity and distance, identity and difference, and violence
and forgiveness—themes explored in this essay as integral parts of global awareness
and engagement as being-in-the-world. What is both salutary and illustrative, however,
is Derrida’s unequivocal commitment to the practice of engagement, particularly with
representatives of the historic Others. See, for example, his conversation with Musta-
pha Cherif in Mustapha Cherif, Islam and the West: A Conversation with Jacques Derrida
(Religion and Postmodernism), trans., Teresa Lavender Fagan (Chicago, IL: University
of Chicago Press, 2008). Indeed, my largest debt to Derrida may lie both in the funda-
mental assertion of the necessity to explore practically and theoretically what “living
together” means—which this essay has called, “global awareness and engagement.”
134
http://www.ascd.org/ASCD/pdf/siteASCD/wholechild/
Lester Edwin J. Ruiz
partnerships that characterize such awareness and engagement; in fact,
effective partnerships constitute the meaning, significance, and definition
of global awareness and engagement itself. Moreover, such partnerships
are fundamentally performative. They come into being as they are lived
out and have no meaning apart from this enactment.
Therefore, any understanding of global awareness and engagement
and the partnerships that constitute it must be linked to some understand-
ing of the nature of actual human bodies and the “body politic”—as ethnos,
demos, and bios—as these are the embodied sites of meaning, performativ-
ity, and spirituality. This essay now turns to these themes.
Bodies, the “body politic,” and Mondialisation: ATS belt-
ways and runways rerouted—a socio-philosophical sight
line
Globalization, Mondialisation, biopolitics
In the English-speaking world, globalization has come to be assumed not
only as the horizon (i.e., a range of vision that includes everything that can
be seen from a particular situation, location, or vantage point) but also as
the way in which totality is grasped as an (intentional) amorphous, undif-
ferentiated whole and as a spatial and temporal extension of a particular
[Euro-American] way of life. The more conventional critique of globaliza-
tion is that it is not only a limited horizon granted universal status but
also that it has led us down a pathway that destroys other ways of life that
stand in the way of its geopolitical, geostrategic, and geocultural exten-
sions [e.g., colonialism, imperialism, patriarchy, cultural chauvinism, and,
more recently, extractivism]. Moreover, globalization as we have inher-
ited it is almost always accompanied, particularly in the Global North,
by a fundamental subterranean epistemological temptation to represent
the world as an act of a self-sufficient, autonomous, “subject of history.”19
Such representation bears resemblances to a Cartesian-like aspiration for
that philosophical, perspectival, and foundational certitude that grounds
all modem thinking, feeling, and acting, as well as a Hobbesian-Lockean-
like anthropology of a possessive and extractive individual that is also an
19 Martin Heidegger, “The Age of World Picture,” in The Question Concerning Technol-
ogy and Other Essays, trans. William Lovitt (New York: Harper and Row, 1977), 115-154.
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epistemological or thinking-knowing subject with the power, privilege,
and opportunity to name or represent, and therefore, to create, the world
in his image: Cogito ergo sum becomes Cogito ergo vinco, and eventuates in
Vinco ergo sum.20 The biblical tradition calls this idolatry.
However, globalization is not the only term or meaning of world that is
available to us. For example, Jean-Luc Nancy argues that “world” in the
French language does not always carry with it the connotations of world
as “globalization.” Nancy foregrounds Mondialisation as that process of
differentiation and formation that “maintains a crucial reference to the
world’s horizon as a space of human relations … of meaning held in
common … of signification or possible signification.”21 In fact, Mondialisa-
tion, unlike its Anglophone counterpart globalization, places the emphasis
not on the representation of the world but on the creative act of forming a
world. And while it is not clear to me that Nancy fully extricates himself
from the representational, apophantic dilemma of globalization conven-
tionally understood, the notion of Mondialisation and its implicit relational,
dialogical, and personal sensibilities offers a possible clearing in the dark
forest of globalization—a place of relational, intersubjective, and bodily
disclosure the ancient Greeks called αλήθεια—in our conversations about
global awareness and engagement.22
In this context, my insistence on understanding “partnerships” in
terms of reference to the body and the “body politic” (as ethnos, demos,
bios), which in this essay is another name for “communities of faith,
learning, and accountability,” is decidedly empirical; I deploy the term
to signify, quite literally, material, concrete, sensuous human bodies not
only as a way to ground and orient my understanding of global awareness
and engagement but also as a way to resist the objectification, reifica-
tion, and commodification of human beings and nature arising out of the
20 C.B. Macpherson, The Political Theory of Possessive Individualism: Hobbes to Locke
(Oxford: Clarendon Press, 1962); Enrique Dussel, History and the Theology of Liberation:
A Latin American Perspective, trans. J. Drury (New York: Orbis Books, 1976).
21 Jean-Luc Nancy, The Creation of the World or Globalization, trans. Francois Raffoul
and David Pettigrew (Albany: State University of New York, 2007), 33-55.
22 In his work, Besinnung (Gesamtausgabe 67), Martin Heidegger lists nine texts where
he examines the question of truth. See Mindfulness, trans. Parvis Emad and Thomas
Kalary (New York: Continuum, 2006). One could make a persuasive argument that the
“question of truth” as disclosure has huge implications for the present state of affairs,
at least in the US context.
136
Lester Edwin J. Ruiz
estrangement [Entfremdung] intrinsic to the dynamics of capitalism’s rela-
tions of production, reproduction, extraction, and representation.231 also
deploy the term philosophically and metaphorically to signify my affini־
ties with what Michel Foucault and those who have followed his lead have
called “biopolitics.”24
The labyrinthine discourses on biopolitics need not detain us here. It
is sufficient to say that they remind us of the necessary role, status, and
function of “the body” whether construed literally, metaphorically, or
biopolitically in discussions of religion, politics, or ministry today, par-
ticularly, where “bare life” itself has become a site of both disciplinary
power and “dispositifs of control.”25 We need only recall that under the sign
of capitalism and sovereignty today, the practical and conceptual divide
between the οίκος and the πόλις, or what the ancient Greeks saw as a dis-
tinction between “natural life” [zoe] and “political life” [bios], can only be
sustained with great difficulty. The collapse of the distinction, as Antonio
Negri points out, results in the “control of populations as a way to govern
life” [itself].26 Life today—and therefore ministry—cannot be extricated
from its multistranded embodiments or from multiple bodies across time,
space, and place. The good life can no longer be recuperated by upholding
the distinction between zoe and bios, since the collapse of the distinction,
under conditions of the exercise and circulation of power of globalizing,
transnationalizing capitalist regimes, has profoundly altered religious and
public life through discipline, punishment, and [dispositifs] of control. This
is evident, for example, in the dynamics of forced migration so starkly
23 Karl Marx and Fredrick Engels, The Economic and Philosophic Manuscripts of 1844
and the Communist Manifesto, trans. Martin Milligan (Amherst: Prometheus Books,
1988); Bertell Oilman, Alienation: Marx’s Conception of Man in a Capitalist Society (Cam-
bridge: Cambridge University Press, 1977).
24 Michel Foucault, ׳The Birth of Biopolitics/’ in Ethics: Subjectivity and Truth, ed.
Paul Rabinow (New York: The New Press, 1997), 73-79; Roberto Esposito, Bios: Bio-
politics and Philosophy, trans. Timothy Campbell (Minneapolis: University of Minnesota
Press, 2008).
25 Giorgio Agamben, What is an Apparatus? And Other Essays, trans. David Kishik
and Stefan Pedatella (Stanford: Stanford University Press, 2009), 2-3; Michel Foucault,
“The Confession of the Flesh,” in Power/Knowledge Selected Interviews and Other Writings
1972-1977, ed. Colin Gordon (New York: Pantheon, 1980), 194-228.
26 Antonio Negri, “The Labor of the Multitude and the Fabric of Biopolitics,” trans.
Sara Mayo, Peter Graefe and Mark Coté, Mediations 23, no. 2 (Spring 2008): 8-25.
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demonstrated recently in Europe or “gentrification” in such areas as
downtown Detroit or Harlem; or the framing of “the good, the true, and
the beautiful” by Silicon Valley, Bollywood, Wall Street, and the fashion
runways of Tokyo, Paris, Milan, and New York; or the proliferation of mul-
tiple iterations of technology (from the technical to the perspectival) and
their multiple applications in realms of the political, the economic, the cul-
tural, and the educational.
A dispersed, displaced, and dislocated (and therefore mobile) body
I have long argued that the “body politic,” including those communities
engaged in accredited graduate theological education, is shaped by, or
more precisely, embedded in, a number of intersecting, but contingent,
mobile, and polymorphic conditions: one, it is dispersed, displaced, and
dislocated; two, it is racialized and ethnicized; and three, it is gendered
and sexualized.27
I have also argued that the transformative dimensions of these inter־
secting conditions, which go by many names, including, for example,
mobility, hybridity, innovation, and improvisation, are compromised by
the fact that significant numbers of the “body politic” have been either dis-
embodied (i.e., expunged from that very body: dismembered, incarcerated,
27 Dietrich Wemer, David Esterline, Namsoon Kang, and Joshva Raja, eds., Handbook
of Theological Education in World Christianity: Theological Perspectives, Ecumenical Trends,
Regional Surveys (Oxford: Regnum Books, International, 2010). See, for example, Lester
Edwin J. Ruiz, “Recovering the Body: When Race and Power Migrate,” 85-103; Lester
Edwin J. Ruiz, “Race, Power, and Migration: Reimagining Graduate Theological Edu-
cation,” in Contemporary Issues of Migration and Theology, eds. Elaine Padilla and Peter
Phan (New York: Palgrave, 2013), 211-231; Lester Edwin J. Ruiz, “I believe in the res-
urrection of the body—meditations and explorations on ׳the religious/ ׳the public/
and the Asian diaspora: a research framework and agenda,” in Asian Christian Review,
(Summer 2013): 63-111.
138
Lester Edwin /. Ruiz
disabled, pathologized, commodified, criminalized, or securitized)28 and
erased and forgotten, not only by modern politics but also by institutions
of the “body politic” itself, including by the government, the military, the
university, the church, and the clinic.29
28 This assertion of these “disembodiments” requires a more complex argument
that a short essay cannot sustain. Because I have made this argument elsewhere, it
is sufficient to suggest here that a fulsome understanding of global awareness and
engagement, even in graduate theological education, will need to attend to the new
geopolitics experienced by many today as being more unapologetically predatory,
even more widespread, almost proto-fascist, and undeniably xenophobic. The reali-
ties of “forced migration,” globally, and of “immigration,” in the US context that have
exploded on the world stage in the past few years (e.g., the “refugee crisis” in Europe,
the US debate on immigration in the United States, and even more poignantly, the
forced migration of communities resulting from “natural” disasters—Puerto Rico,
Florida, Texas, California)—particularly the responses to certain sectors of the body
politic—reveal a profound reliance on a geopolitical understanding that is state-centric,
juridically-bounded, administratively implemented, and an intentionally exclusionary
aggregate of competing interests. It is a spatial and temporal extension of a partie-
ular North Atlantic way of life, articulated in terms of structures and processes that
privilege sovereign states and their bureaucratic apparatuses as the legitimate form of
planetary life. Those who are “strangers” (or Others) to these structures and processes,
or who do not conform or comply, are treated as criminals or as “security risks” —
hence the phrase “bodies that are criminalized, incarcerated, and securitized,” or are
excluded or minoritized because of disability or pathology. This is not new, of course,
but the point directly relevant to this essay is not only that these crises are ethical prob-
lems requiring a response, but rather that this understanding of geopolitics that has
come to be assumed not only as the horizon (i.e., a range of vision and its accompa-
nying practices that includes everything that can be seen from a particular situation,
location or vantage point), but also as the way in which totality is grasped, making it
both an ontological and epistemological matter to be addressed. See Lester Edwin }.
Ruiz, “Conversations with Migrant Advocates: Do we believe in the resurrection of the
body?” in The Intersections of Migration, Human Rights, and Development Justice, Liberato
Bautista and Mervin Toquero, eds. (New York and Quezon City: NCCP & GBCS UMC,
2014), 81-106; Lester Edwin J Ruiz, “Afterword: CWWM’s Journey From New York to
Berlin—Finding Our Way Home,” in Turning Strangers into Friends: Hospitality, Mercy,
Justice, Liberato C. Bautista, ed. (Quezon City: National Council of Churches in the
Philippines, 2017), 65-76.
29 Saskia Sassen calls this “expulsions” in her book, Expulsions: Brutality and Com-
plexity in the Global Economy (Cambridge: Belknap Press, 2014). See also Mark Lewis
Taylor, The Executed God: The Way of the Cross in Lockdown America (Minneapolis:
Augsburg Fortress Publishers, 2015); Elizabeth Barnes, The Minority Body: A Theory
of Disability (Oxford: Oxford University Press, 2016); Nancy Leong, “Racial Capital-
ism,” Harvard Law Review 126, no. 8 (June 2013): 2,151-2,226. See, more generally,
Karl Marx, “The Fetishism of Commodities and the Secret Thereof” in https://web.
stanford.edu/~davies/Symbsysl00-Spring0708/Marx-Commodity-Fetishism ,
accessed December 22, 2017. See also, for example, https://boxedambivalence.word-
press.eom/2008/06/08/ql-commodification-of-the-female-body/, accessed December
22, 2017.
139
https://web
https://boxedambivalence.word-press.eom/2008/06/08/ql-commodification-of-the-female-body/
https://boxedambivalence.word-press.eom/2008/06/08/ql-commodification-of-the-female-body/
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Four things can be said concerning the first condition. First, the disper-
sal, displacement, and dislocation of bodies cannot be explained by any
one theory, although one of the suggestive metaphors for the changes that
are occurring worldwide has been that of turbulence, suggesting by its
use not mere motion, activity, or movement, but disruptive, unpredict-
able, volatile speed.30 Second, there is a compelling argument to be made
that these changes are, in fact, part of what Anthony Giddens called “the
consequences of modernity,” including (1) the separation and emptying
of time and space, (2) the development of disembedding mechanisms like
symbolic tokens and expert systems, and (3) the reflexive appropriation of
knowledge.31 Third, these conditions are not only structured and sustained
by the movements and flows of capital, people, goods, information, ideas,
and images; they are, in fact, socially constructed by the very actions and/
or activities of those individuals and communities that have been globally
dispersed, displaced, and dislocated. And, fourth, these dispersals, dis-
placements, and dislocations—while creating conditions of estrangement,
marginalization, antagonism, exclusion, even disintegration and anomie,
and what Zygmunt Bauman calls the “endemic uncertainty of liquid
modernity”32—have also given rise to languages and experiences of multi-
plicity, plurality, and difference as well as hybridity, intersectionality, and
liminality, and therefore to the possibilities of transformation, innovation,
and improvisation in political, economic, cultural, and religious life.
A racialized and ethnicized body
Two things may be said concerning the second condition. First, follow-
ing the work of the “critical race theorists,” it is important not to yield to
the temptation of the “uncritical use of biological and essential concep-
tions of race as premises of antiracist struggles,” and to acknowledge that
“the term ‘race’ may be so historically and socially overdetermined that it
30 Nikos Papastergiadis, The Turbulence of Migration: Globalization, Deterritorialization
and Hybridity (Cambridge: Polity Press, 2000), 3-21.
31 Anthony Giddens, The Consequences of Modernity (Stanford: Stanford University
Press, 1990), 16-50.
32 Zygmunt Bauman, Liquid Times: Living in an Age of Uncertainty (Cambridge: Polity
Press, 2007), 4-26.
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Lester Edwin J. Ruiz
is beyond rehabilitation.”33 At the same time, following Ronald Takaki, it
may be important to assert that racial experience is both quantitatively and
qualitatively different from ethnic experience and, therefore, to be careful
not to reduce “race” to “ethnicity” or “cultural identity.”34 An undiffer־
entiated view fails to account for the centrality of race in the histories of
oppressed groups and therefore underestimates the degree to which tradi-
tional notions of race have shaped, and continue to shape, the societies in
which we live, including through the decisive, far reaching area of law.35
Second, drawing on the work of Michael Omi and Howard Winant—
which deploys the term “racialization” to signify “the extension of racial
meaning to a previously racially unclassified relationship, social practice
or group,” thereby underscoring the “contingent and changing nature of
race and racism while recognizing its pervasive and systematic effect on
our history”36—we can argue that there can be no homogenous or unitary
notion of race and that its meaning, of necessity, will not only arise out of
its multistranded contexts but also will have multiple accounts: biological,
social, cultural, essential, strategic, and political. With Chong־Soon Lee we
might conclude not only that “race as ethnicity may actually hinder our
ability to resist entrenched forms of racism” but that race as a creature
irreducible to ethnicity is needed in order to understand that colonialism,
say in Africa, as an expression of imperialism, is both about racial domina-
tion and ethno-cultural oppression.37 It may be, as well, that the notion of
(white) privilege or (white) supremacy globally construed may be a more
productive framework for addressing this form of oppression, especially
in order to move the discourse beyond the “white/black” racial binary.
Such a construal of race also provides opportunities to discover how the
33 Jayne Chong-Soon Lee, “Navigating the Topology of Race,” in Critical Race Theory,
eds. Kimberle Crenshaw, Neil Gotanda, Gary Peller, and Kendall Thomas (New York:
The New Press, 1995), 441.
34 Ronald Takaki, A Different Mirror: A History of Multicultural America, rev. ed. (New
York: Back Bay Books, 2008).
35 Kimberle Williams Crenshaw, “Race Liberalism and the Deradicalization of Racial
Reform,” Harvard Law Review 130, no. 9 (October 2017): 2,298-2,319. See also Nancy
Leong, “Racial Capitalism,” note 28.
36 Michael Omni and Howard A. Winant, Racial Formation in the United States from the
1960s to the 1980s (New York: Routledge, 1986), 68.
37 Chong-Soon Lee, “Navigating the Topology of Race,” 442.
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different ways one’s racialized and ethnicized contexts and origins are
constitutive of transformative theological education.
A gendered and sexualized body
Concerning the third condition, I have argued that much can be learned
about the body and the “body politic” from the struggles of feminist,
womanist, and Mujerista, as well as lesbian, gay, bisexual, trans, queer,
and intersexed [LGBTQI] members of the “body politic,” not only to regain
control of their bodies, but also to recuperate the places of their bodies in
religious and public life.
In the first place, these struggles to recover the place of the body in
religious and public life involve different ways of producing, reproducing,
and valuing (different) knowledges (epistemologies), consistently focused
on the necessity of rethinking the relationship between reason and desire
and the construction of conceptual models that demonstrate the mutually
constitutive rather than oppositional relationship between them. In the
second place, these struggles to recover the place of the body in religious
and public life involve different modes of being (ontologies), insisting not
only that thinking, feeling, and acting are relational practices but also that
bodies—more than passive, sexualized biological objects—can be refig-
ured and reinscribed. In the third place, these struggles to recover the
place of the body in religious and public life involve different forms of
consciousness (subjectivitities), not only acknowledging that conscious-
ness arises out of concrete and sensuous activity but also that subjectivity
itself is performative and that spirituality is always and already ecologi-
cally-embedded and embodied experience, including different practices
of touching, feeling, smelling, tasting, eating, imagining, and making love.
In the fourth place, these struggles to recover the place of the body in reli-
gious and public life involve different empowering practices (politics),
recognizing not only the importance of self-definition, self-valuation, self-
reliance, and self-determination but also the necessity of transformation,
transgression, and resistance, and of finding shared safe places and clear
voices in the midst of difference—particularly where the asymmetries of
power are mediated through structures and processes that legitimize or
naturalize some differences and not others.
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Lester Edwin J. Ruiz
A spirituality of global engagement: the religio-moral as
being-in-the-world
Avta Brah and Ann Phoenix, in a 2004 essay titled, ‘Ain’t I A Woman?
Revisiting Intersectionality,” demonstrate through the use of autobiog-
raphy and empirical studies that “social class [and its intersections with
gender and ‘race’ or sexuality] are simultaneously subjective, structural,
and about social positioning and everyday practices.” Especially intriguing
is the conclusion to the essay that invites reflection on the “potential con-
tributions to intersectional analysis of theoretical and political approaches
such as those associated with poststructuralism, postcolonial feminist
analysis, and diaspora studies.”38
Intersectionality directs our gaze to at least three important reli-
gio-moral questions: the nature of the social totality, the character of
subjectivity, and the challenge of practice, this time articulated as the ques-
tion of “effective partnerships.” But why are they important?
First, the importance of attending to the nature of the social totality
underscores the importance of embodied connections of space, time, and
place. Richard Thompson Ford argued, for example, that racial segregation
in the United States is created and perpetuated by racially identified space
and that the latter “results from public policy and legal sanctions . . . ,”39
which, I will add, are played out—articulated, represented, implicated—
on the actual bodies of human beings. In a different though not unrelated
context, Foucault may be interpreted as underscoring the rearticulation of
the social totality when he observes that “a whole history remains to be
written of spaces—which would at the same time be the history of powers
(both these terms are in the plural)—from the great strategies of geopoli-
tics to the little tactics of the habitat… passing via economic and political
38 Avta Brah and Ann Phoenix, “Ain’t I a Woman? Revisiting Intersectionality”
Journal of International Women’s Studies 5, no. 3 (2004): 75-86; Avta Brah, Cartographies of
Diaspora: Contesting Identities, (New York: Routledge, 1996), 17-83. See also, Giorgio
Agamben’s notion of “apparatus” in What is an Apparatus? and Other Essays, trans.
David Kishik and Stefan Pedatella (Stanford, CA: Stanford University Press, 2009), 2-3.
See also, Michel Foucault’s dispositif in “The Confession of the Flesh,” 194-228.
39 Richard Thompson Ford, “The Boundaries of Race: Political Geography in Legal
Analysis,” Critical Race Theory, note 32, 449-465.
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installations”40—not only from the Global North to the Global South, but
also within the Global South.
Second, where subjectivity is concerned, the recognition of actual
bodies as multiple, multistranded, and multifaceted performative sites
fundamentally challenges all ahistorical, essentialist, nonrelational, and
reified construals of “the Subject” and directs us not only to the ques-
tion “What is to be done?” but also to the questions of identity: “who we
are, what we hope for, where we are going, how do we get there?” This
“reinstalls” the notion of subjectivity within a much deeper, broader, inter-
sectional, relational, ecological, and performative whole. My insistence on
situating “the Subject” in these ways is an attempt to side-step the long
and destructive shadow cast by the anthropocentric, auto-referential, phil-
osophical, epistemic, and political Sovereign of that part of Euro-American
life associated with “modernity” or “the Enlightenment.” In this context,
race, gender, sexuality, and security are not only the extensions or effects
of human action; they are also entanglements of structure, process, agency,
ecology, and thought.
Third, where the performative and therefore challenge of practice is
concerned, such bodies direct us to the intersections of a peoples’ plural-
istic and are therefore always and already contradictory, antagonistic and
agonistic economic, cultural, political, and religious histories—there not
only to be reminded of the importance of context for ministry but also to
be directed toward the religio-moral as “practical-critical activity.41 The
challenge is not only to link theory and praxis, thought and action, spirit
and matter, but also “to grasp the root of the matter . . . man [sic] himself
[sic]”—as sensuous human activity, (i.e., practice [performance]).To put
the matter boldly, global awareness and engagement as the practice of
effective partnerships is concrete, sensuous, human activity.
40 Michel Foucault, “The Eye of Power,” Power/Knowledge Selected Interviews and
Other Writings 1972-1977, ed. Colin Gordon (New York: Pantheon, 1980),
146
-149.
41 Karl Marx and Friedrich Engels, Selected Works, vol. 1, trans. W. Lough (Moscow:
Progress Publishers, 1969), 13-15; Karl Marx, “Contribution to the Critique of Hegel’s
Philosophy of Law,” Deutsch Französische Jahrbücher (1844), http://www.marxists.org/
archive/marx/works/l843/critique-hpr/intro.htm, accessed October 15, 2017.
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Lester Edwin J. Ruiz
Conclusion: the futures of global awareness and engage־
ment—the heart of the matter
Focusing on the metaphor of “the body” as sensuous human activity
brings the conversation both of global awareness and engagement and the
religio-moral imperative of “effective partnerships” into the domain of the
categorically personal, not only in the sense that it touches our lives (the
phrase in ATS־style accreditation is “high touch”) but also that we bear
simultaneous unconditional responsibility for the good, the true, and the
beautiful, as well as the bad, the false, and the ugly ( i.e., we own but
do not control them). It also allows us to shine light (Heidegger’s image
of light and clearing in the Schwarize Wald of Baden-Württemberg) on the
practices of accredited graduate theological education—which arguably
is a necessary but much larger task than is possible in this brief essay. My
more modest goal in this essay has been to suggest some reasons for the
need to reframe the conversation on global awareness and engagement by
bringing it more fully into the realm of everyday personal practice as effec-
tive partnership without separating the conversation from its ontological
and epistemological connections. However, one more caveat needs to be
stated—namely, while the personal may be necessary, it is not a sufficient
condition of possibility for effective partnerships.
“Three things remain,” Saint Paul reminds us: “faith, hope, and love;
but the greatest of these is love” (1 Corinthians 13). In fact, theologically
put, at the heart of the religio-moral is the ineffable, irrepressible, exces-
sive, and unconditional love of God. Without this love—given to us in
its contingency, impurity, and at great cost in the life, death, and resur-
rection of Jesus, and through the communities of faithful struggle both
named and unnamed throughout history—the religio-moral would be an
empty shell; global awareness and engagement would be less meaning-
ful; ministry would only limp along. Love itself is performative as it is
fundamental; it is constitutive as it is transformative. And while we essen-
tialize and romanticize it only at our own peril, with some certainty we
can say that existentially, without love, there can be no passion or com-
passion, no unconditional forgiveness, no vulnerability, and no genuine
humility. Love makes courage, resistance, and struggle bearable; it makes
diakonia necessary and it makes mutual respect, decency, and recognition
of difference obligatory. Separated from love, empowerment, integrity,
and righteousness would be mere dogma; there would be very little
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tenderness, or kindness, or enduring joy. Love invites curiosity, wonder-
ment, and awe. It contextualizes goodness, truth, and beauty. It sustains
justice, modulates power, and nourishes transformation.
The “heart of the matter” is that global awareness and engagement,
theologically and existentially comprehended, are about effective, loving,
embodied partnerships that—in the context of ATS—are foregrounded
as a “big tent ecumenicity” that includes theological/ecclesial diversity,
in addition to the more conventionally-accepted racial/ethnic, gender,
and missional diversities long recognized by the Association and the
Commission. And where these reach to “the global,” they must include
constituencies and publics that involve individuals and groups from the
historic Protestant, Evangelical, Pentecostal, Roman Catholic, Orthodox,
and Independent Churches (e.g., in Africa and China)—a practice for
which ATS is known not only in its work among its member schools but
also in its involvements with “partners” outside the United States and
Canada. The diverse gifts and virtues that these communities of faith bring
to the table, when taken together and bound by love, inspire what ATS
calls the “improvement and enhancement of [both] theological schools
[and theological education] to the benefit of communities of faith and the
broader public.”42
Strategically, I want to suggest that the future, if not relevance, of ATS
as a “North American” institution implicated in the realities of “global
Christianity” rests on its capacity to institutionally embody “global aware-
ness and engagement” with global sensibilities as an intentional horizon, a
sixty-thousand-foot sightline, if you will, for its work. Programmatically,
I want to suggest, that the future of global awareness and engagement, in
the ATS context, is exemplified in the kind of work of the Global Forum
42 ATS Mission Statement, https://www.ats.edu/about, accessed October 15, 2017.
Where diversity and inclusion are concerned, the truism was, even without theological
or ecclesial orthodoxy, in the past ATS was held together by an educational orthodoxy
(e.g., the MDiv, residential education, and graduate-level theological education), and
that now, without an educational orthodoxy, the challenge is to find that which will
hold the organization together. My own sense now is that despite all the diversity that
can divide, all our member schools actually cannot disagree that our God is a gracious
God—and when this graciousness is embodied in ATS practice, all the diversities can
be “parked” in the presence of such grace, thereby allowing member schools to “live
well together finally.” How this grace looks institutionally, I believe, remains the chai-
lenge for the future.
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Lester Edwin J. Ruiz
of Theological Educators—a relatively new initiative that ATS has helped
birth as part of its previously noted Global Awareness and Engagement
initiative.
Designed to provide an opportunity for leaders in theological educa-
tion from every Christian tradition to meet and learn from those doing
similar work but whose faith tradition might be different from their own,
the purpose of GFTE was to establish a common platform for theologi-
cal educators to share experiences and explore commitments and areas
for potential collaboration. The role of ATS in the development of GFTE
has been significant, primarily due to ATS’ reputation as inclusive and
not privileging one group or ecclesial family over another. As a primary
objective of GFTE is to develop trust among theological educators across
the long-established boundaries, ATS’ commitment to maintaining a “big
tent” in which everyone is welcome and no particular agenda is allowed to
take precedence over others has been particularly important. As described
in the final report of the meeting, “People talked across boundaries—both
ecclesial and geographical—that many participants had not crossed pre-
viously. Perhaps more importantly, people listened to commitments of
persons from Christian families that they had not heard before.”
I wish to conclude this essay by noting, yet again, what lies at the core
of both the initiative and the Forum—and which Daniel Aleshire, during
his term as executive director of ATS, had the ecumenical wisdom and
grace to see and from which he had the courage and humility to insist on
our learning from again and yet again. To put the matter boldly, it was
his practical insistence on “big tent ecumenicity” in the context of the chai-
lenges of world Christianity and the call for transformation in accredited
graduate theological education that are his gift and legacy, as well as the
hope of many.43
43 See Daniel Aleshire, ״The Future has Arrived: Changing theological education
in a changed world,” Theological Education 46, no. 2 (2011): 69-80, where he signals the
need, perhaps, even the necessity, of continuity and change, conflict and collabora-
tion, and the recreation of accredited graduate theological education in light of the
fundamental importance of theological/ecclesial diversity, in addition to the more con-
ventionally-accepted racial/ethnic, gender, and missional diversities long recognized
by the Association. See also, Daniel Aleshire, “Diversity in Theological Education and
Ecumenical Engagement: Diversity among the Theological Schools of North America,”
in Theological Education and Theology of Life, eds. Atóla Longkumer, Po Ho Huang, and
Uta Andree (Eugene, Oregon: Wipf and Stock Publishers, 2016), 208-217.
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Of Beltways, Runways, and Sight Lines
Excerpts from “The Concluding message of the Global Forum of
Theological Educators (GFTE)” are instructive as they are prophetic and
summative for future work:
. . . The GFTE’s composition is unique . . . key theologi-
cal educators from the six major church confessional
families—Orthodox, Roman Catholic, Protestant, Evan-
gelical, Pentecostal, and Independent churches—gathered
together in one united forum in order to learn from one
another and to share about the current situation of theo-
logical education and ministerial formation on a global
scale … to underline the common tasks that face all Chris-
tian traditions. Some of these tasks include: building up
new leadership for the mission of the church, strengthen-
ing the sense of unity among Christians, giving witness to
justice with peace in the world, and supporting all aspects
of theological education. The meeting was characterized
by a deep sense of humility and of mutual openness in
prayer and dialogue …
… In our many contexts, we realize again that unity and
cooperation in theological education beyond the tradi-
tional divides are not a luxury or mere specialized vocation
for some, but are essential to the future of theological edu-
cation. Cooperation and dialogue in theological formation
are required for the majority of settings where the church
finds itself in the twenty-first century …
. . . We are aware that we can complement one another
and need one another with the different gifts we bring
to the common table in the area of theological education.
The need to overcome stereotypes and caricatures of one
another is crucial not just for theological education but
also for our witness in a world that is tom apart by wars,
violence, and so many types of injustice. We have been
made aware of the need to continue conversations started
in this first gathering, to foster friendships and collabora-
tion birthed from our dialogue, and to seek together, as
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Lester Edwin J. Ruiz
educators, to work toward transformative theological edu-
cation that serves the churches and God’s kingdom.44
Lester Edwin J. Ruiz is Senior Director of Accreditation and Institutional Evalua-
tion at The Association of Theological Schools in Pittsburgh, Pennsylvania.
44 Global Forum of Theological Educators, “Concluding Statement.” http://www.
ataasia.com/concluding-message-of-the-global-forum-of-theological-educators-gfte/,
accessed April 16, 2018. See also http://gfte.org, accessed May Î, 2018.
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