The diversity and contextuality of ethical situations encountered by physiotherapists in the South America region of World physiotherapy, Spain and Portugal – a cross-cultural, qualitative analysis

Limited research exists on ethical landscapes in physiotherapy in South America, Spain, and Portugal. The study aimed to explore the diversity and contextuality of preexisting ethical situations and to identify novel ethical situations encountered by physiotherapists in these regions. A cross-sectional online survey incorporating one optional open-ended question was conducted, adapted from the ESPI-study and translated into Spanish and Portuguese. Participants were asked to describe ethical situations they experienced. Qualitative data were analyzed deductively and inductively and novel ethical situations categorized thematically. Participants included 98 physiotherapists from 11 countries. The qualitative analysis revealed 94 ethical situations, with 78 relating to predefined survey items, and 44 ethical situations concentrating on seven survey items. Reported situations included professional misconduct in educational settings, conflicts with other health professionals and patients, lack of professional recognition and knowledge about physiotherapy scope, inadequate regulatory infrastructure and economic pressures. Sixteen novel ethical situations formed four new themes: (1) inadequate compensation and devaluation of physiotherapy services, (2) work exploitation and labor rights violations, (3) managing interpersonal violence and neglect within patients’ environments, and (4) gender-based professional disrespect. Findings highlight how structural hierarchies, cultural norms, and gender biases shape ethical challenges of physiotherapists. The study underscores the need for targeted ethics education, stronger professional advocacy, and systemic reforms to address labor rights and gender equity. The study reveals complex ethical realities faced by physiotherapists in South America, Spain, and Portugal, and calls for context-sensitive strategies to enhance professional autonomy, equity, and ethical preparedness.