Transcript The Ethical Mandate of - Ohio Occupational Therapy Association

THE ETHICAL
MANDATE OF
Occupational
Therapy
Always do right. This will gratify
some people, and astonish the rest.
Mark Twain
Never let your sense of morals
get in the way of doing what’s
right.
Isaac Asimov
Morality, like art, means drawing a
line someplace.
Oscar Wilde
Those are my principles, and if you
don’t like them … well, I have others.
Groucho Marx
Learning Objectives
1. Explain the ethical mandate for occupational therapy
2.
3.
4.
5.
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 one’s awareness of ethics in
practice.
Identify ethical issues and pose potential solutions to
case materials.
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
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
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
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 another’s obligation to do something for me
• Do the right thing out of obligation to the individual’s 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
Case Example
Should the federal government require all
employers to include birth control in their
healthcare coverage for their employees?
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
Deontology
What universal principles need to be implemented here?
• Religious rules about life and the need not to infringe on it
• Government’s 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
Rights Theory
Whose rights need to be met and how do we prioritize
them?
• Women’s rights to equal, relevant healthcare
• Society’s right to less burden for unwanted children
• Institutions’ right to decide what interferes with their
values and mission
• Individuals’ right to choose
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
OT Code of Ethics
Purpose
1. Identity and describe the principles supported by the
occupational therapy profession
2. Educate the general public and members regarding
established principles to which occupational therapy
personnel are accountable
3. Socialize occupational therapy personnel new to the
practice to expected standards of conduct
4. Assist occupational therapy personnel in recognition
and resolution of ethical dilemmas
(AOTA, 2010, p. 2)
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
Core Values & Attitudes of Occupational
Therapy Practice
1.
Altruism - unselfish concern for others
2.
Equality - perceiving all individuals as having same
fundamental human rights and opportunities
3.
Freedom – allowing the individual to exercise choice,
to demonstrate independence, initiative, and selfdirection
Core Values & Attitudes of Occupational
Therapy Practice
4.
Justice - value of upholding moral and legal principles,
such as fairness, equity, truthfulness, and objectivity
5.
Dignity - valuing the inherent worth and uniqueness of
each person
6.
Truth - requires that we be faithful to facts and reality
7.
Prudence - ability to govern and discipline oneself
through the use of reason
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
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.
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.”
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.”
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).”
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.”
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 society’s occupational needs.
OT Ethical Mandate
We are entrusted with promoting health and
participation through engagement in occupation.
• Understand occupation beyond its commonsense meanings
• Define occupation and occupational therapy to
our stakeholders
• Promote the role of engagement in occupation in
health
• Advocate for everyone’s right to occupation,
health, and participation
Enacting the Mandate
• Appreciate our unique role and its responsibilities.
• Embody the ethos of occupational therapy.
• Recognize our ethical mandate with every client –
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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.
Questions about Ethics
• How do we decide the merits of the Patient Protection and
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•
•
•
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?
Ethics Resources
• Ethics committees
• Institutional review boards (IRBs)
• AOTA
• NBCOT
• Ohio OT, PT, AT Licensure Board
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, 1085–1086.
Beauchamp, T.L. & Childress, J.F. (2009). Principles of bioethics, 6th ed.
New York: Oxford University Press.
References
Doherty, R.F. (2009). Ethical decision making in occupational therapy
practice. In Crepeau, E.B., Cohn, E.S., & Schell, B.A. Willard and
Spackman’s 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.
Model for Ethical Decision-Making
1.
2.
3.
4.
5.
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
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)
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
Principles Governing Review of Breach of
Ethics
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
1.