Mark Twain

Isaac Asimov

Oscar Wilde

Groucho Marx

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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.

• 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

• 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

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

Rights Theory – focuses on rights of individuals affected
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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
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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

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

What is the greatest good for each party involved in this decision?
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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

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

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
• I nstitutions’ right to decide what interferes with their values and mission
• Individuals’ right to choose

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

Purpose
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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
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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)

• 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

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Altruism - unselfish concern for others
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Equality - perceiving all individuals as having same fundamental human rights and opportunities
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Freedom – allowing the individual to exercise choice, to demonstrate independence, initiative, and selfdirection

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Justice - value of upholding moral and legal principles, such as fairness, equity, truthfulness, and objectivity
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Dignity - valuing the inherent worth and uniqueness of each person
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Truth - requires that we be faithful to facts and reality
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Prudence - ability to govern and discipline oneself through the use of reason

• 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
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Unique role in promoting health
Goal of services – participation
• Applies to all people: occupational justice

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.

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.
”

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.
”

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 ).”

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 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 .

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

• 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.

• 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?

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

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, 2 nd 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, 6 th ed .
New York: Oxford University Press.

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, 11 th 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
20 th 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.

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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

Overview
• Apply to all occupational therapy personnel
• Designed to protect the public
• Established and maintained by the AOTA
Commission on Standards and Ethics (SEC)

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

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Complaint brought
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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