RECTH 5350 

Ethical Decision-Making Process

November 25, 2020

Nikita Rogers, Grace Nakamura, Lexi Mireles 

Identify and Summarize the Ethical Concern  

At Carmen B. Pingree Autism Center of Learning, an adolescent student was engaging in

maladaptive behavior of hitting other students and yelling during the Recreational

Therapist’s intervention following a recipe to make food. The Recreational Therapist of that

student intervened by not allowing the student to eat lunch/food made during the intervention or

leave the classroom for the rest of the day. Under the ATRA code of ethics, this scenario first

violates principle 1: beneficence. Principle 1 states, “Recreational Therapy personnel shall treat

persons served in an ethical manner by actively making efforts to provide for their well-being by

maximizing possible benefits and relieving, lessening, or minimizing possible harm.” As a

Recreational Therapist, in this situation, it is important that the safety of the student engaging in

maladaptive behavior, as well as anyone around the student, is prioritized. It is vital to ensure

that if there is any way to deescalate the situation quickly and efficiently that steps are taken to

do so. Identifying the reasons for the escalation in the student will help the teacher relieve,

lessen, or minimize possible harm to the student and/or others. 

The second principle this scenario correlates with is principal 2: non-maleficence.

Principle 2 states, “Recreational Therapy personnel have an obligation to use their knowledge,

skills, abilities, and judgment to help persons while respecting their decisions and protecting

them from harm.” The Recreational Therapist in this scenario had an obligation to use their

expertise to deescalate the situation while still respecting and keeping the dignity of that student

intact. The safety of the other student’s, any teachers present, and the Recreational Therapist

themself, needed to take precedence when taking the appropriate action in intervening the

student’s aggressive behavior. 

   The third principle applied to this situation is principle 3: autonomy. Principle 3 states,

“Recreational Therapy personnel have a duty to preserve and protect the right of each individual

to make his/her own choices. Each individual is to be given the opportunity to determine his/her

own course of action in accordance with a plan freely chosen. In the case of individuals who are

unable to exercise autonomy with regard to their care, recreational therapy personnel have the

duty to respect the decisions of their qualified legal representative.” The Recreational Therapist

should make certain that the student has the right to exercise their autonomy, while doing so,

ensuring the protection of that individual, and anyone else involved, if that choice puts others in

harm's way. The Recreational Therapist took away the student’s autonomy in restricting their

right to choose to eat lunch as well as the right to choose to leave the classroom either to use the

restroom or to join in with the rest of the class if they were to leave the room. 

The fourth principle is principle 9: competence. It states, “Recreational therapy personnel

have the responsibility to maintain and improve their knowledge related to the profession and

demonstrate current, competent practice to persons served. In addition, personnel have an

obligation to maintain their credential.” It is a requirement by law that the Recreational Therapist

is maintaining the appropriate credential to practice as a health care professional. This credential

entails obtaining and then demonstrating the needed knowledge and competence in providing

treatment as a Recreational Therapist. This mentioned competence should have been

demonstrated in the situation with the student presenting aggression.

Lastly, principle 10: laws and regulations, states, “Recreational Therapy personnel are

responsible for complying with local, state and federal laws, regulations and ATRA policies

governing the profession of Recreational Therapy.” The restriction of the student being able to

eat lunch as well as leaving the classroom classifies as a direct violation with the principle and
complying to laws and regulations that ensure the safety and well-being of the student or any

person.

Recognize a Moral Issue 

The RT responded to the aggression of the student by withholding any food or

accessibility outside of the classroom for the remainder of the day. This is at the interpersonal

level and an infringement of the student’s right to eat as well as choice to go beyond the

classroom to use the restroom, go outside, or participate in other class activities. This is a moral

issue because it takes away the student’s ability to eat lunch for that day as well as violates the

Recreational Therapists responsibility to provide for the student’s overall well-being and protect

them from anything harmful or from unfair treatment. 

Begin the Decision-Making Process

Because an adolescent student was hitting other students and yelling while making food,

the Recreational Therapist had to act and decide what was the best way to handle the situation.

The Recreational Therapist decided that the best consequence for this adolescent student was to

restrict them from eating and leaving the classroom for the rest of the day. It ended up that the

recreational therapist, the student engaging in aggression, the other students, and teachers all

became involved and were affected by this situation. Even though everyone has obligations in all

situations, the recreational therapist has the biggest obligation. His or her obligation is to

minimize harm to the patient and others around the patient. But luckily, the Recreational

Therapist had ultimate control over the situation.

Brainstorm Alternatives

As with any kind of outcome, there are always going to be things you could have done

differently or approached the situation from an alternative angle. One of the alternative

approaches the Recreational Therapist could have done instead of restricting the student and not

feeding them is blocking the student from harming other students or redirecting the student by

having them take time to calm down and sit out for the rest of the intervention. But of course,

with coming up with alternatives, you must think of the different outcomes and consequences

that come with it. Some possible outcomes of the alternatives listed above could be de-escalating

the situation, the student could still eat and have the opportunity to participate in other activities,

or it might just not work at all. 

Points of Views

Using the “Approach the Ethics” table, we can decipher how ethical the decision-making

process was by the recreational therapist. From an outsider perspective, it seems like the

Recreational Therapist did not think in an ethical manner when deciding how to handle the

situation. This will go over each approach and show how it relates to this certain situation and

how the Recreational Therapist could have handled it better ethically.

The first approach is The Virtue Approach which states, “What is ethical is what

develops moral virtues in ourselves and our communities”. In this situation, the Recreational

Therapist did not let the student eat for the rest of the day because of their actions during a food

intervention, which does not follow moral virtues and/or being ethical. The second approach is

The Utilitarian Approach which states, “Of any two actions, the most ethical one will produce

the greatest balance of benefits over harms”. In this situation, the Recreational Therapist was not
focused on the student’s overall well-being in the actions/policies put into place. The actions

harmed the student instead of benefiting them. The third approach is The Rights Approach which

states, “An action or policy is morally right only if those persons affected by the decision are not

used merely as instruments for advancing some goal, but are fully informed and treated only as

they have freely and knowingly consented to be treated”. In this situation, the student has the

right to be respected and treated as a free person, but the Recreational Therapist did not allow the

student to practice that right. They portrayed this by locking the student away from everyone else

and not letting them participate in any activities or eat the rest of the school day.

The fourth approach is The Fairness Approach which states, “Treat people the same

unless there are morally relevant differences between them”. In this situation, the student should

be treated the same as any other student when it comes to discipline and not the way the student

was actually punished. Especially because there was no moral difference between that student

and the others. The fifth and final approach is The Common Good Approach which states, “What

is ethical is what advances the common good”. In this situation, the common goal of the school

is to provide a healthy environment for students to learn and engage. Unfortunately, the

Recreational Therapist did not provide that for this student. 

Each Alternative 

Having an alternative action in mind is beneficial for knowing how to react in the future

and learning from mistakes. There are many different alternatives that could have been taken,

however the three that we thought were the best in this case, would have the most benefit for the

student. The alternative actions would be first, redirecting the student to a remote area to allow

them to calm down and then return to intervention when ready. Second, take the student aside to
deescalate the situation and then prohibit the student from participating in any RT interventions

for the rest of the day. Lastly, when the aggressive behavior occurs, the recreational therapist will

intervene and implement consequence strategies immediately to stop aggression and allow the

student to calm down and assist them in transitioning back to the intervention. 

First Alternative

In this scenario with the student showing aggression towards others, the Recreational

Therapist could have first, redirected the student away from the other people in the room by

prompting the student to take time to calm down in an isolated safe area and sit out for the

remainder of the intervention. Second, the RT could have prompted the student to utilize coping

skills to help the student communicate their reason for aggressing. Then, when the student is

visibly calm and ready, they can rejoin the other students in the intervention. This would be the

most beneficial for the student engaging in aggression, other students participating in the

intervention, and the recreational therapist. This is because the student would no longer be able

to harm other students by being in a calm secluded space, where they are able to exercise healthy

coping skills to deescalate, as well as be able to continue participating in the intervention when

they are ready . The RT would benefit from this in there would be less disruption and risk of

reescalation while progressing in the intervention. All obligations would be met in this

alternative action. This alternative would produce a higher rate of positive consequences and

provide an opportunity for the student to use healthy coping skills, reduce the likelihood of

aggression occurring in the future, and ensure the safety of all students and staff without

compromising the dignity of the student. 

Second Alternative

The second alternative of this scenario would involve the Recreational Therapist first,

intervening the student who is displaying aggression by taking them to the side and prompting

appropriate coping and communication skills, and second, prohibiting that student from

participating in interventions for the rest of the day. The second action would present a better

alternative than what took place in being more beneficial to the student, other students and the

RT. Though this scenario would pose a better alternative than what took place, not having the

student that displayed aggression participate for the rest of the day could be considered a waste

of a day for the student and inhibit them from gaining beneficial therapeutic treatment from the

Recreational Therapist. Positive consequences would be the student has the opportunity to learn

new coping skills, preventing similar aggression to reoccur in the future. On the other hand, this

alternative of prohibiting the student from participating in interventions may be demeaning to the

student and would not be able to benefit from them. The student’s aggressive behavior could

hold the risk of increasing due to this prolonged negative consequence. 

Third Alternative 

During the intervention, when the student became upset and began hitting the students

sitting next to them, the Recreational Therapist would intervene. They would respond by

blocking the student from hitting the other students and then prompt the student to use

appropriate communication and coping skills to stop the aggressive behavior and apologize to

the student while still in close proximity to the other students. This would benefit the student in

learning important skills in replacing aggression with verbal communication to express

frustration as well as benefit the fellow student whose hair was pulled in communicating to the

student that what they did hurt them and that it was not okay. Possible consequences to this
scenario would be that the student could re-escalate and continue to pull hair or display other

aggressive behaviors and more action would need to take place to intervene. The student could

also deescalate quickly and effectively and rejoin the intervention with little disruption to the

other students and the overall intervention. If the student had displayed very minor aggression,

this alternative would be appropriate, however, because the student showed no signs of stopping

aggressive behavior, greater action was needed to deescalate the situation. 

Make a Decision

Overall, the first alternative action treats all parties in a fair manner, is best for all

concerned, would make a good rule for people to live by in similar situations and would lead to

the best overall consequences. The first alternative permits the student to fully deescalate from

the situation in a safe manner and respects their dignity by allowing them the opportunity to talk

about how they’re feeling to the Recreational Therapist away from the other students in a quiet

environment. It would also give the student the needed time to calm down without distraction or

risk of escalating again.  The Recreational Therapist can utilize this scenario as a learning

opportunity and implement therapeutic strategies aligned with the student’s personal goals

relating to communication and emotional expression. This gives the student the chance to

demonstrate skills learned by the Recreational Therapist while receiving positive reinforcement

for that demonstration. The student will then be able to transition smoothly back to the remainder

of the intervention. 

Though the second alternative adequately demonstrated the appropriate way to deescalate

the situation, prohibiting the student from being able to participate in any interventions for the

rest of the day is a restriction of their rights of therapeutic treatment from the Recreational

Therapist. They would miss out on strengthening and developing important skills demonstrated
by the Recreational therapist, socializing with their peers, and participating in the interventions

that are focused on the student’s treatment goals. 

The third alternative is appropriate for a situation with minor aggressive behaviors

shown, however, with the severity of the student’s violent actions, the Recreational Therapist

needed to take further action by removing the student from the current environment to fully

deescalate. For future incidents, if the student’s aggressive behavior declined and portrayed

adequate communication and expression, then this alternative would be best used for low risk

situations that may occur. 

Group Reflection
 
After going through the decision-making process with each of the different scenarios, we

have learned the importance of understanding ethics and how it comes into practice. Having the

skills and knowledge of how to go through the ethical decision-making process will be beneficial

for when difficult decisions arise whether working as healthcare professionals or in our everyday

lives. There are many different scenarios that could come up during an intervention with clients

or coworkers and being prepared for how to react will prevent ethical dilemmas. 

During this assignment, we realized the various alternative actions that could take place

during one situation. It is important to utilize the ethical decision-making process in morally

conflicting scenarios; considering the best form of action to take that meets the ATRA code of

ethics and ensures the client is receiving the utmost care. Overall, determining the best ethical

approach to any given situation will result in the most adequate quality care provided to the

client.