Chapter 32 Ethical Decision Making in Occupational Therapy Practice Regina F. Doherty

“Practitioners must be grounded not only by a moral conscience to do what is right, but also by the courage to proceed and ensure the best interests of the patient.” Brandt & Homenko, 2011

Learning Objectives After reading this chapter, you will be able to: Recognize the ethical issues that occupational therapy practitioners encounter in clinical practice. Understand basic ethical theories and approaches to ethics. Understand and apply an ethical decision-making guide for case analysis.

Learning Objectives (Continued) Understand and apply ethical reasoning as a construct within the clinical decision-making process. Identify and know how to access ethics resources. Understand effective communication strategies for difficult conversations.

Why Ethics? Ethical questions often arise for OTs in day-to-day practice Practitioners must recognize ethical situations and possess the capacity and willingness to address these situations systematically Knowledge and understanding of ethical reasoning and decision making are essential components of occupational therapy practice

Ethics, Morality, and Moral Reasoning Ethics is a branch of philosophy involving systemic study and reflection on morality Morality refers to social conventions about right and wrong human conduct Sets the stage for ethical behavior Moral reasoning is used to reflect on ethical issues Ethics provides the mechanism for this process Ultimately, moral reasoning results in a course of action

Ethical Implications of Trends in Health Care and Occupational Therapy Practice Common ethical issues that occupational therapy practitioners encounter include the following: Confidentiality and disclosure; Quality of life; Clients’ decision-making capacity; and Personal and professional boundaries

Ethical Implications of Trends in Health Care and Occupational Therapy Practice (Continued) Use of power Resource allocation and priorities in treatment Cultural, religious, and family considerations Balancing benefits and harm in the care of patients

Ethical Implications of Trends in Health Care and Occupational Therapy Practice (Continued) The most frequently cited ethical issues reported relate to: Reimbursement; Conflicts around goal-setting; and Clients’/caregivers’ inadequate follow-through with recommendations

Virtues of Health Care Professionals Health care professionals hold a unique societal role because the public expects them to uphold particular virtues: Benevolence; Competence; Objectivity Caring; and Compassion

Distinguishing among Clinical, Legal, and Ethical Problems in Practice Practitioners must learn to distinguish ethical questions from other questions encountered during client care Ethical issues should be distinguished from: Miscommunication; Clinical issues; and Legal issues

Reflection and Ethical Practice Recognizing the morally significant features of a situation is the first step in ethical practice Reflection is a form of self-assessment that can be used to improve practice Values clarification Mindfulness Use of oral and written narratives

Identifying Different Types of Ethical Problems An ethical problem is a situation believed to have negative implications and that poses a difficult choice Practitioners should distinguish among the different types of ethical problems that occur in clinical practice Ethical distress Ethical dilemma

Ethical Theories and Principles that Apply to Clinical Practice Ethical theories provide a language for diagnosing, communicating, and problem solving ethical questions in clinical practice Principle-based approach Virtue- and character-based ethics Utilitarianism Deontology

Ethical Resources and Jurisdiction Ethics committees Institutional review boards Codes of ethics

Regulatory Agencies Three types of organizations provide oversight for occupational therapy practice: The American Occupational Therapy Association National Board for Certification of Occupational Therapy State Regulatory Boards

The Ethical Decision-Making Process The ethical decision-making process provides a way for practitioners to give due consideration to issues: Identify the ethical question Gather the relevant data Formulate a moral diagnosis Problem-solve practical alternatives and decide on an alternative for action Act on the choice and evaluate the results

Difficult Conversation OT practitioners who are empathetic are better prepared for difficult conversations Open communication and empathy are key components to the delivery of compassionate care: Be present Use open-ended communication and listen quietly Remain focused on the person and the goals of intervention Be contrite and humble

Difficult Conversation (Continued) Legitimize the losses that the person is experiencing If you are having difficulty with an issue, think how the problem might be experienced from the client’s perspective Acknowledge “the elephant in the room” Pay attention to the words you use and how you use them