Title: The Ethical Mandate of
1The Ethical Mandate of
2Always do right. This will gratify some people,
and astonish the rest. Mark Twain
3Never let your sense of morals get in the way of
doing whats right. Isaac Asimov
4Morality, like art, means drawing a line
someplace. Oscar Wilde
5Those are my principles, and if you dont like
them well, I have others. Groucho Marx
6Learning 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.
7What 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
8What 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
9Major 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
10Major 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
11Case Example
- Should the federal government require all
employers to include birth control in their
healthcare coverage for their employees?
12Utilitarianism
- 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
13Deontology
- 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
14Rights 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
15Communitarianism
- 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
16OT 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)
17Core 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
18Core 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
19Core 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
20OT 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
21OT 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.
22OT 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. -
23OT 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.
24OT 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).
25OT 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.
26OT 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.
27OT 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
28Enacting 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.
29Questions 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?
30Ethics Resources
- Ethics committees
- Institutional review boards (IRBs)
- AOTA
- NBCOT
- Ohio OT, PT, AT Licensure Board
31References
- 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.
32References
- 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.
33Model 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
34Enforcement 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)
35Steps 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
36Principles Governing Review of Breach of Ethics
- Complaint brought
- Evidence gathered and reviewed
- Complainant notified
- Preliminary decision made on grounds for breach
- Formal hearing held includes evidence,
witnesses, and rebuttal - Decision made
- Sanction levied
- Appeals made
- Final determination
- Sanctions publicized