The Ethical Mandate of

1. The Ethical Mandate of Occupational Therapy

2. Always do right. This will gratify some people, and astonish the rest. Mark Twain

3. Never let your sense of morals get in the way of doing what’s right. Isaac Asimov

4. Morality, like art, means drawing a line someplace. Oscar Wilde

5. Those are my principles, and if you don’t like them … well, I have others. Groucho Marx

6. Learning 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 one’s awareness of ethics in practice. • Identify ethical issues and pose potential solutions to case materials.

7. 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

8. 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

9. 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

10. 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

11. Case Example Should the federal government require all employers to include birth control in their healthcare coverage for their employees?

12. 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

13. 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

14. 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

15. 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

16. OT 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)

17. Core Values ofOT 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

18. Core 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

19. Core 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

20. 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

21. 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.

22. 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.”

23. 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.”

24. 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).”

25. 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.”

26. 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.

27. OT 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 everyone’s right to occupation, health, and participation

28. Enacting 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.

29. Questions 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?

30. Ethics Resources • Ethics committees • Institutional review boards (IRBs) • AOTA • NBCOT • Ohio OT, PT, AT Licensure Board

31. 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.

32. 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.

33. Model 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

34. 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)

35. 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

36. Principles 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