Adriana Turtura

OTH 510

Dr. Imamshah

9/13/2023

ICA 3: Ethics

1) You are working with an individual who experienced a left CVA resulting in right-sided

movement problems. This individual requires a lot of assistance at home with all basic daily

activities, but they have good potential to benefit from occupational therapy services to become

more independent. This client’s insurance only covers the first 30 minutes of their therapy

sessions. Meaning, if 120 minutes of therapy are provided, only 30 minutes of them will be

reimbursed. Due to this client’s clinical presentation, they need more than 30 minutes of

treatment per session. However, because of their insurance’s poor reimbursement structure, your

employer tells you to keep all treatments with this individual to 30 minutes.

a. What is one core value that is at stake and why?

• Altruism because the employer is more concerned about fee reimbursement than

the welfare of the client.

b. When attempting to understand and navigate this situation, what principle will best

assist you with making sound ethical decisions and why?

• Benefice because OTs shall demonstrate concern for the well-being of clients.

c. What standards of conduct may be involved in this situation and why?

 • Service Delivery because OTs must provide an appropriate evaluation and plan of

intervention specific to the client’s needs.

2). You are working in a privately owned neurological rehabilitation center with an

interprofessional team composed of occupational, physical, and speech therapists, education

specialists, athletic trainers, behavior analysts, case managers, and physicians. There are also

aides who assist with the daily treatments of the clients; clients are typically complex in their

presentation (i.e., they have a lot of physical, behavioral, and cognitive health problems). All

professionals wear identification badges that have their names but not their profession identified.

The aides, on the other hand, are identified as Neurological Rehabilitation Specialists.

a. What is one core value that is at stake and why?

• Truth because the ID badges do not accurately depict the qualifications of the

personnel wearing them.

b. When attempting to understand and navigate this situation, what principle will best

assist you with making sound ethical decisions and why?

• Veracity because OTs shall provide accurate information when representing the

profession.

c. What standards of conduct may be involved in this situation and why?

• Service Delivery because OTs shall describe the type and duration of occupational

therapy services accurately in professional contracts, including the duties and

responsibilities of all involved parties.

3) You are working with an older adult in an inpatient facility who has a terminal health

condition. This client has low energy, depression, and is generally deconditioned due to lack of

activity. In addition, they often refuse therapy because of feelings of depression, poor timing of

therapy visits, and lack of interest in the therapeutic activities the other therapists are offering.

Many of the therapists do not pay much attention to this client or put much energy into trying to

engage them in therapy because of the frequent refusals.

a. What is one core value that is at stake and why?

• Altruism, because OTs shall protect and defend the rights of others, even if they

are terminally ill.

b. When attempting to understand and navigate this situation, what principle will best

assist you with making sound ethical decisions and why?

• Beneficence because it requires taking action to benefit others.

c. What standards of conduct may be involved in this situation and why?

• Service Delivery because OTs shall use, to the extent possible, intervention techniques

that are evidence-based and within the recognized scope of OT practice.

4) You are working with a young adult client in a skilled nursing facility. This client has been

working with the occupational therapy assistant for several days. When you, the supervising

occupational therapist, check in with the client to see how therapy has been going, they tell you

that the assistant spends about 20 minutes with them before leaving and uses that time to chat

about daily events and do a few upper body resistance band exercises while seated. As the

supervising therapist who wrote this client’s plan of care and reviews the assistant’s daily notes,
you have concerns about what the client has told you, especially because the assistant is billing

for 60 minutes of treatment time.

a. Use the 6-step process for ethical reasoning to navigate this situation. For steps 1-5, use

the “Considerations” column to inform the process.

• I would want to hear both sides of the story, so I would ask for the assistant’s

version of events. I would also fact-check with other personnel who may have

observed the sessions.

• If the accusation is true, the client is experiencing an interruption in service

delivery and the assistant is unjustly billing and collecting fees for services that

were not rendered. It is the OT therapist’s obligation to address the problem.

• Ethical values = Altruism & Truth, Principles = Beneficence & Veracity,

Standards of Conduct = Provide appropriate evaluation and a plan of intervention for

recipients of occupational therapy services specific to their needs; Bill and collect fees

justly and legally in a manner that is fair, reasonable, and commensurate with services

delivered.

b. For step 6, write a personal reflection addressing the following:

i. How did it make you feel knowing that the situation described above is a true

story? How does it make you feel knowing that some therapists and assistants bill

for services that were never provided?

• It made me feel angry on behalf of the client because their needs were not

being met. It made me frustrated with the assistant because the medical
 billing system is complicated enough. Fraudulent claims cause financial

losses as well as loss of credibility for clients.

ii. What strengths do you possess that would support your ability to effectively

navigate ethical dilemmas?

• Transparency, responsibility, and empathy are three strengths of mine that

support my ethical decision-making ability.

iii. What weaknesses do you possess that would hinder your ability to effectively

navigate ethical dilemmas and what could you do to improve in these areas?

• Time pressure is a weakness. When I am under time constraints, I

sometimes act less ethically to produce a result. Just acknowledging that is

an issue has made a big difference for me. In doing so, I feel more

empowered to ask for the extra time required to get the most ethical result.