The Ethical Mandate of

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The Ethical Mandate of

• Occupational Therapy

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Always do right. This will gratify some people,
and astonish the rest. Mark Twain
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Never let your sense of morals get in the way of
doing whats right. Isaac Asimov
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Morality, like art, means drawing a line
someplace. Oscar Wilde
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Those are my principles, and if you dont like
them well, I have others. Groucho Marx
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Learning Objectives

• Explain the ethical mandate for occupational
  therapy services.
• Discuss the relationship of the occupational
  therapist to society.
• Describe some of the more prominent approaches to
  addressing ethical issues.
• Describe ways to raise ones awareness of ethics
  in practice.
• Identify ethical issues and pose potential
  solutions to case materials.

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What are Ethics?

• Concerned with what is right and good
• Emanate from values
• Norms or methods for conducting human affairs
• Held both internally and externally
• Universal and particular

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What are Ethics?

• Manifested in the moral imperative, What ought I
  to do?
• Ethics ? laws
• Ethics are complex
• Ethical dilemmas
• Taking one action precludes taking another
  ethically mandated action
• Lack of clear rules or rules need specification
  and balancing
• Each situation is unique
• Emotional involvement complicates situations

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Major Ethical Approaches

• Utilitarianism seeks greatest good for all
  individuals affected
• Ends justify means
• Case-based approach
• Do the right thing based on what is best for each
  individual affected
• Deontology based on universal principles and
  rules
• Morality is grounded on reason
• Need to act according to moral obligation
• Do the right thing for the right reason

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Major Ethical Approaches

• Rights Theory focuses on rights of individuals
  affected
• Each individual has basic rights that must be
  protected and upheld
• My right assumes anothers obligation to do
  something for me
• Do the right thing out of obligation to the
  individuals rights
• Communitarianism concerned about the common
  good
• Good of society, or the common good, trumps
  individual rights
• Seeks to build the good society
• Do the right thing out of obligation to society

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Case Example

• Should the federal government require all
  employers to include birth control in their
  healthcare coverage for their employees?

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Utilitarianism

• What is the greatest good for each party involved
  in this decision?
• Who are the parties?
• What is good for each?
• Individual women exert autonomy get needed
  resources control their own health be treated
  as equals avoid undue financial, emotional, and
  familial stress
• Employer healthier workforce support values and
  mission sustain business enterprise control
  costs
• Society fewer unwanted pregnancies seen as
  caring for the needs of citizens keeping people
  healthy

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Deontology

• What universal principles need to be implemented
  here?
• Religious rules about life and the need not to
  infringe on it
• Governments laws about treating everyone equally
• Laws about not intruding on the lives of
  individuals and institutions
• Principle of having to balance our federal and
  state budgets
• Principle of individual responsibilities

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Rights Theory

• Whose rights need to be met and how do we
  prioritize them?
• Womens rights to equal, relevant healthcare
• Societys right to less burden for unwanted
  children
• Institutions right to decide what interferes
  with their values and mission
• Individuals right to choose

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Communitarianism

• What is the common good?
• Healthy communities
• Undue burden on some for the sake of others
• Fiscal solvency
• Individual rights are subordinate to the good of
  all

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OT Code of Ethics

• Purpose
• Identity and describe the principles supported by
  the occupational therapy profession
• Educate the general public and members regarding
  established principles to which occupational
  therapy personnel are accountable
• Socialize occupational therapy personnel new to
  the practice to expected standards of conduct
• Assist occupational therapy personnel in
  recognition and resolution of ethical dilemmas
• (AOTA, 2010, p. 2)

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Core Values of OT Profession

• Codifies the beliefs and ideals of the group
• Lays the foundation to guide actions
• Ideally all members embrace (voted)
• Reflected in interactions with clients,
  colleagues, society at large
• Actions and attitudes of members are a reflection
  of the values
• AOTA, 1993

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Core Values Attitudes of Occupational Therapy
Practice

• Altruism - unselfish concern for others
• Equality - perceiving all individuals as having
  same fundamental human rights and opportunities
• Freedom allowing the individual to exercise
  choice, to demonstrate independence, initiative,
  and self-direction

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Core Values Attitudes of Occupational Therapy
Practice

• Justice - value of upholding moral and legal
  principles, such as fairness, equity,
  truthfulness, and objectivity
• Dignity - valuing the inherent worth and
  uniqueness of each person
• Truth - requires that we be faithful to facts and
  reality
• Prudence - ability to govern and discipline
  oneself through the use of reason

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OT Ethical Mandate

• Over-arching goal of occupational therapy
  services - supporting health and participation in
  life through engagement in occupation (OT
  Practice Framework, 2008)
• View humans as occupational beings
• Role of OT use occupations to support health
  and participation
• Unique role in promoting health
• Goal of services participation
• Applies to all people occupational justice

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OT Ethical Mandate

• Adolph Meyer
• Described a pattern of life for all humans
  following rhythms of life work, play, rest, and
  sleep
• Occupational therapy needs to apply the
  principles of establishing and maintaining
  balance by engaging patients in routines of
  occupation.
• The role of the occupational therapist is to
  provide opportunities rather than prescriptions.

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OT Ethical Mandate

• William Rush Dunton
• We believe that occupation is as necessary to
  life as food and drink. That every human being
  should have both physical and mental occupation.
  That all should have occupations which they
  enjoy That sick minds, sick bodies, sick souls,
  may be healed through occupation.

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OT Ethical Mandate

• Mary Reilly
• My reexamination of our early history revealed
  that our profession emerged from a common belief
  held by a small group of people. This common
  belief is the hypothesis upon which our
  profession was founded. It was, and indeed still
  is, one of the truly great and even magnificent
  hypothesis sic of medicine today. I have dared
  to state this hypothesis That man, through the
  use of his hands as they are energized by mind
  and will, can influence the state of his own
  health.

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OT Ethical Mandate

• Elizabeth Yerxa
• Human beings are meaning creators. One of the
  raw materials of such meaning is action in the
  form of satisfying occupation. Perhaps this was
  the great insight of Adolph Meyer (1922) when he
  proposed that occupational therapists provide
  opportunities (I, we) rather than prescriptions
  (it, they).

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OT Ethical Mandate

• Suzanne Peloquin
• We are pathfinders. We enable occupations that
  heal. We cocreate daily lives. We reach for
  hearts as well as hands. We are artists and
  scientists at once. If we discern this in
  ourselves, if we act on this understanding every
  day, we will advance into the future embracing
  our ethos of engagement.

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OT Ethical Mandate

• OT Centennial Vision Statement -
• By the year 2017 we envision that occupational
  therapy is a
• powerful,
• widely recognized,
• science-driven, and
• evidence-based profession with a
• globally connected and diverse workforce
• meeting societys occupational needs.

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OT Ethical Mandate

• We are entrusted with promoting health and
  participation through engagement in occupation.
• Understand occupation beyond its common-sense
  meanings
• Define occupation and occupational therapy to our
  stakeholders
• Promote the role of engagement in occupation in
  health
• Advocate for everyones right to occupation,
  health, and participation

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Enacting the Mandate

• Appreciate our unique role and its
  responsibilities.
• Embody the ethos of occupational therapy.
• Recognize our ethical mandate with every client
  practice occupation-based, client-centered care.
• Care deeply about the welfare of those we serve.
• Work with our teams.
• Educate and advocate.
• Use best available evidence to support practice.
• Recognize ethical issues.
• Address ethical issues using available resources.
• Support and participate in our professional
  organizations.

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Questions about Ethics

• How do we decide the merits of the Patient
  Protection and Affordable Care Act?
• By accepting the current healthcare restrictions
  on OT practice, are we complicit in denying the
  care they need and that will allow them to lead
  fuller, more productive lives?
• How do we work in environments that restrict our
  scope of practice?
• Should occupational therapists address societal
  issues such as obesity, teenage pregnancy,
  suicide, mass killings?
• Should we allow others to not understand OT?

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Ethics Resources

• Ethics committees
• Institutional review boards (IRBs)
• AOTA
• NBCOT
• Ohio OT, PT, AT Licensure Board

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References

• American Occupational Therapy Association.
  (2010). Occupational therapy code of ethics and
  ethics standards. American Journal of
  Occupational Therapy, 64, 17-26.
• American Occupational Therapy Association.
  (2008). Occupational therapy practice framework
  Domain and process, 2nd ed. American Journal of
  Occupational Therapy, 62, 625-683.
• American Occupational Therapy Association.
  (2007). Centennial Vision and executive summary.
  AJOT, 61, 613-614
• American Occupational Therapy Association.
  (1993). Core values and attitudes of occupational
  therapy practice. American Journal of
  Occupational Therapy, 47, 10851086.
• Beauchamp, T.L. Childress, J.F. (2009).
  Principles of bioethics, 6th ed. New York Oxford
  University Press.

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References

• Doherty, R.F. (2009). Ethical decision making in
  occupational therapy practice. In Crepeau, E.B.,
  Cohn, E.S., Schell, B.A. Willard and
  Spackmans occupational therapy, 11th ed.
  Philadelphia Lippincott Williams and Wilkins.
• Dunton, W.R. (1919). Reconstruction therapy.
  Philadelphia Saunders.
• Meyer, A. (1977). The philosophy of
  occupational therapy. American Journal of
  Occupational Therapy, 51, 639-642.
• Peloquin, S.M. (2005). Embracing our ethos,
  reclaiming our heart. American Journal of
  Occupational Therapy, 59, 611-625.
• Reilly, M. (1962). Occupational therapy can be
  one of the great ideas of 20th Century medicine.
  American Journal of Occupational Therapy, 16,
  2-9.
• Yerxa, E.J. (1967). Infinite distance between
  the I and the It. American Journal of
  Occupational Therapy, 63, 490-497.

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Model for Ethical Decision-Making

• Identify the ethical question.
• Gather the relevant data.
• Formulate a moral diagnosis.
• Problem-solve practical alternatives and decide
  on an option for action.
• Act on the choice and evaluate the results.
• Doherty, p. 280

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Enforcement Procedures for the OT Code of Ethics

• Overview
• Apply to all occupational therapy personnel
• Designed to protect the public
• Established and maintained by the AOTA Commission
  on Standards and Ethics (SEC)

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Steps for Dealing with a Breach of Ethics
Notify Regulatory Board
Talk to a confidant.
Witness a potential breach of ethics
Confront the offender.
Verify a breach occurred
Handled locally
Notify NBCOT
Go to a supervisor.
Notify AOTA
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Principles Governing Review of Breach of Ethics

1. Complaint brought
2. Evidence gathered and reviewed
3. Complainant notified
4. Preliminary decision made on grounds for breach
5. Formal hearing held includes evidence,
   witnesses, and rebuttal
6. Decision made
7. Sanction levied
8. Appeals made
9. Final determination
10. Sanctions publicized