ETHICAL PRACTICE

• What would I say to a patient who asked me if I could be his “Facebook friend” while he was
undergoing active treatment on the unit where I practice?

• They require practitioners to recognize ethical situations and have both the capacity and the
willingness to address these situations systematically.

• Ethics in occupational therapy involves thoughtful reflection, critical reasoning, justification,

action, and evaluation of moral decisions.
• Ethics is a branch of philosophy that involves systemic study and reflection pro- viding
language, methods, and guidelines to study and reflect on morality (Doherty & Purtilo, 2016).

• Ethical dilemmas are often intricate and ever-evolving, necessitating additional knowledge,
communication with interprofessional colleagues, and consultation with various resources.
• MORALITY:
• Three Types of Morality: There are three main types of morality - personal (individual beliefs and
values), group (shared values within a profession or organization), and societal (values held by society
as a whole).

• Preserving Integrity: Personal morality aligns with an individual's values and preserving one's
integrity. It's about acting in accordance with one's personal beliefs.

• Professional Values: Group morality, like that of a professional organization such as AOTA,
guides collective decisions and may emphasize specific values like collaborative practice and
occupation.
• Changing Societal Values: Societal morality reflects the values of society as a whole, and it
evolves over time. Different communities may champion different values and rights.

• Interplay and Tension: Tensions can arise between these three moral realms, and in a diverse
society, no single moral vision prevails. This complexity makes ethical decision-making
challenging.

• Moral reasoning is a reflective process that leads to ethically supported actions.

 ETHICAL IMPLICATIONS OF TRENDS IN
PRACTICE
• Moral distress is an ethical problem that occurs when practitioners know the right thing to do but
cannot achieve it because of external barriers or uncertainty about the outcome (Doherty &
Purtilo, 2016).

• Moral distress in OT practice ?

• Reimbursement constraints
• Issues related to client decision-making capacity and safety
• Confidentiality and disclosure
• Difficult client behaviours
• Upholding professional standards and values
• Resource allocation and systematic issues
• Health professionals have a distinctive societal responsibility to embody essential virtues, such as
integrity, benevolence, competence, kindness, trustworthiness, fairness, conscientiousness, care,
and compassion.

• Compassion is “the recognition, empathic understanding of and emotional resonance with the
concerns, pain, distress or suffering of others coupled with motivation and relational action to
ameliorate these conditions” (Lown & McIntosh, 2015, p. 3)

• Recognizing the morally significant features of a situation is one of the first steps in ethical
reflection.
• Reflection is a form of self-assessment used to improve practice and competence.

• Mindfulness is a way of tuning in to what is happening in and around us (Schoeberlein & Sheth,
2009).
• An ethical problem is a situation that is believed to have negative implications regarding
cherished moral values and duties and that will pose an extremely difficult choice to an
individual or group of individuals (Doherty & Purtilo, 2016).

• This may become evident through emotional responses like discomfort, anxiety, or frustration.
Often, practitioners express it by saying, "Something doesn't seem right." This emotional
reaction acts as a prompt to initiate ethical contemplation.
 MORAL THEORIES AND ETHICAL PRINCIPLES

• Moral theories are well-developed, systematic frameworks of rules and principles.( Nash,2002).
• The most commonly used ethical approaches are :
• Principle-based approach
• Virtue and character based ethics
• Utilitarianism
• Deontology
 PRINCIPLE-BASED APPROACH
• Principles are duties, tights, or other moral guidelines that provide a logical approach to analyzing
ethical issues for a given situation.

• In case analysis, principles are identified, applied, and compared to weigh one principle against
another in deciding a course of action.
• The following principles are commonly used in health care:
• Autonomy.
• Beneficence.
• Nonmaleficence.
• Fidelity.
• Justice.
• Veracity.
 VIRTUE AND CHARACTER-BASED ETHICS

• Virtues are dispositions of character and conduct that motivate and enable practitioners to
provide good care (Fletcher, Miller, & Spencer, 1997),
• Using this approach, moral goodness is achieved when behaviors are chosen for the sake of
virtue (caring and kindness) rather than obligation.
 UTILITARIANISM

• Utilitarianism, derived from the work of Jeremy Bentham and John Stuart Mill, is concerned
with actions that maximize good consequences and minimize bad consequences.

• The ethical action is one whose outcome brings about the most good or the least harm overall
(Doherty & Purtilo, 2016). Utilitarianism is often used in public policy development.
• From this perspective, morally right acts produce the best overall results; that is, the ends justify
the means.
 DEONTOLOGY

• Deontology is a duty-based moral theory that is based primarily on the work of Immanuel Kant.

• In this theory, moral rules are universal and never to be broken; consequently, doing one’s duty is
considered primary, regardless of the consequences.

• A practitioner would never keep the truth from a client even if the truth would harm the client in
some way. From a Kantian perspective, respect for people is a moral imperative; therefore,
withholding the truth. Disrespects the client's right to know.
THE ETHICAL DECISION MAKING PROCESS
• Ethical decision-making is integral to professional reasoning, offering a structured process for
practitioners to consider issues, reflect, generate alternatives, and make thoughtful choices, all
while prioritizing client-centered care and moral conduct.

• Common aspects of all ethical decision-making models are the need for the practitioners to do
the following :
• Recognize and define the ethical question.
• Gather the relevant data.
• Formulate a moral diagnosis and analyze the problem using ethics theory/principles.
• Problem-solve practical alternatives, weight options, and decide on an action.
• Act on a morally acceptable choice.
• Evaluate and reflect on the process/action/ results.
 ETHICAL RESOURCES AND JURISDICTION

• Ethics Committees :
• The three primary roles of ethics committees are consultation, education, and policy review and
development.
• Ethics committees provide an environment for safe and open discussion of basic moral questions, ease
the feelings of staff, provide knowledgeable resources, and empower practitioners and families to
make morally justified decisions.

• Practitioners in settings without ethics committees should seek counsel in a timely manner from
mentors, managers, administrative supports, and professional organizations for appropriate
assistance with ethical issues.
 INSTITUTIONAL REVIEW BOARDS

• To ensure an objective review of ethical issues related to human subject research, any institution
that receives federal funding is required to have an institutional review board (IRB).

• An IRB is a panel of diverse individuals, including organization staff and at least one community
member, who are responsible for reviewing all research proposals and grants to ensure that
adequate protections for the research participants.
• These protections include informed consent, research design and methodology, recruitment, the
balance of risks and benefits, and confidentiality.
• The three fundamental principles are autonomy, beneficence, and justice (National Commission
for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979).
 CODES OF ETHICS

• Codes of ethics are written documents produced by professional associations, organizations, or

regulatory bodies that state the commitment to a service ideal, core purpose, or standard of
conduct.

• Codes of ethics are often aspirational, educational, and regulatory in nature (Banks, 2004).

• The values articulated in the ethical code serve to guide professional practice.
• The “Occupational Therapy Code of Ethics” (AOTA, 2015a) serves as a guide
for professional conduct. Along with the “Standards of Practice for Occupational
Therapy”
• The primary purpose of the “Occupational Therapy Code of Ethics” (AOTA,
2015a) is to :
• 1. Provide aspirational Core Values that guide members toward ethical courses of action in
professional and volunteer roles and
• 2. Delineate enforceable Principles and Standards of Conduct that apply to AOTA members.
 REGULATORY ANGENCIES

• 1.AOTA
• 2.NBCOT
• 3.STATE REGULATORY BOARD
• National board for certification in Occupational Therapy :
• The NBCOT is a credentialing agency that provides certification for the OT profession.

• Its mission is to “serve the public interest by advancing client care and professional practice through
evidence-based certification standards and the validation of knowledge essential for effective practice
in occupational therapy” (NBCOT, 2017).

• The NBCOT Certificate Code of Conduct (NBCOT, 2016) outlines professional responsibilities for
certified OT practitioners.

• NBCOT Certificant Code of Conduct includes ethics-related principles such as integrity, responsibility,
honesty, fairness, and technical competence.

• Violation of this code of conduct is grounds for sanction, which may entail reprimand, probation, or
suspension or revocation of certification.
• The NBCOT Qualifications and Compliance Review Committee oversees certification violation
issues such as breaches of ethics and unprofessional practice.

• The NBCOT notifies SRBs and the public of any complaints it receives and the disciplinary
action it takes in response to these complaints.
 STATE REGULATORY BOARDS

• State regulatory boards or licensing boards safeguard and promote the public welfare by ensuring
that qualifications and standards for professional practice are properly evaluated, applied, and
enforced (Doherty & Peterson, 2016).

• State regulatory boards have the authority by state law to discipline OT practitioners who violate
regulations, including the state’s code of conduct. Practitioners have the responsibility to
understand the regulations under which they work and the procedure for processing a complaint.
• The following are suggestions for effective communication:
• Be present.
• Use open-ended communication and listen quietly.
• Remain focused on the person and the goals of intervention,
• Be contrite and humble,
• Legitimize the losses that the person is experiencing,
• Ensure shared decision making.
• Make a team effort.
• “The tools of ethical decision making include developing ‘habits of thought’ for reflection on
complex, changing situations that are part of everyday practice.” —JENSEN (2005)