Ethical Considerations Related to International Fieldwork
Purpose:
1. Identify and document ethical issues, including those related to cross cultural and practice
factors that must be considered when negotiating an international placement.
2. Stimulate discussion by providing questions to ponder when evaluating the benefit/harm
ratio of each placement.
3. Encourage fieldwork educators and students to articulate the value of ethical clarity in
benefit of AOTA members and the global connectedness of the Centennial Vision.
Introduction: The following is presented to generate discussion regarding ethical issues that
may arise while planning international fieldwork placements. In addition, this document may be
presented as issues for students to discuss or consider. Questions may trigger and promote
dialogue about content and potential dilemmas. This document is meant to raise awareness of
ethical issues to consider when planning for an international fieldwork experience.
Accompanying guides and documents should also be reviewed for other essential elements to
consider when planning an international fieldwork.
Questions to Ponder by Category:
Certification considerations:
 Will the international experience prepare the student sufficiently for certification?
 Should the student’s home country fieldwork assignment be specifically chosen to offer
solid certification preparation in order to complement the international experience and
offset any gaps related to requirements for certification?
 Is the academic OT/OTA program aware that international experiences are often
scheduled as optional placements beyond required fieldwork?
Clarity:
 Is there advance verification in writing of the type(s) of population, location, duration,
credentials of fieldwork educator, supervision, contact persons, housing, hours, days of
work per week, days when facility is closed for the international fieldwork placement?
 Is it clear that there will be no guaranteed replacement of the student(s) at the end of the
agreed upon period of service?
Communication:
 Is there clarity about availability of means for communication in the geographical
location of the assignment (telephone contact, e-mail, voice over Internet, etc.)?
 How will necessary off-site communication be handled between FWE /preceptor/
coordinator and student?
Competence:
 Does the student have the professional competencies to serve the population under the
supervision that will be available?
 What professional competencies are expected by the fieldwork site?
 Has the academic OT/OTA program provided the titles, descriptions, and outlines of the
occupational therapy courses that the student has completed?
 Is cultural sensitivity a required part of the preparation for an international experience?
Cultural aspects:
 Have the student and educational program reviewed cultural competencies significant to
the population to be served?
 Will the student appropriately be able to engage with staff and clients at the international
fieldwork site?
 If a student requests a placement in a culturally different environment than his or her
culture of origin, does the student have the awareness, knowledge, and skills to work in
the culturally different environment?
 If a key goal of international fieldwork is to expose students to varied cultures, should a
request for fieldwork placement in the country of origin be pursued?
 Is the student a person who will respect the culture of the assigned site?
 Does the student demonstrate some advance research/awareness of the cultural norms of
the country to be visited?
 Is the student willing to abide by the dress code of the fieldwork site?
 Will the student be comfortable among individuals dressed according to the norms of the
country?
 To what degree are religious differences a concern?
Environmental conditions:
 Will the student be able to function within the environmental conditions likely to be
encountered?
 How much detail should be explored regarding insect infestation, drinking water, crime,
etc., in preparation for the placement?
 What health services/alerts should the student investigate in advance?
 Are there current US State Department warnings in place?
Financial Issues:
 Is it ethically responsible to pursue a potential agreement before assuring that funding
will be available to implement it?
 Who (student, academic OT/OTA program) is responsible for exploring potential funding
sources?
 What is the anticipated cost of travel at the time of the placement? Are Internet-based
reduced-fair bookings or equivalent an acceptable alternative to an established travel
agency?
 Has the student been referred to the college’s study abroad office or equivalent? Does the
student need to meet specific requirements for the college?
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At what stage should the student be asked how much he or she can contribute to the
expected expenses?
Have food costs been included in the overall package so that the student will not have to
choose between eating or paying for a commuter bus or needed materials?
Housing:
 If the potential fieldwork educator offers to have the student stay in his or her home for a
minimal fee, should the college/educational program consider the possibility?
 Are there special needs/special requirements?
 What are the merits of the various options when values and morality are considered?
What is most appropriate in the host country?
 Does the student meet the criteria for on-site housing? How many students are assigned
per room? Are there mixed genders?
 Is public transportation available between the housing site and the clinical service site?
How long is the commute? Will there be issues regarding hitching a ride, involving staff
in transportation,, having to cover taxi costs?
 Is walking between housing and treatment site feasible and safe according to the
standards of the host country?
Impact on Population and Beyond:
 Will there be a possibility for replacement of the student when he or she leaves to carry
on the services provided? Does it matter?
 What is the balance between doing good and harm if after being provided with
occupational therapy the population has no ability to continue receiving service after the
student leaves?
 Is there the possibility of even brief training of individuals in the community for
carryover in order to maximize the value of a one-time intervention?
 Will the student’s sharing of information about conditions and salaries in the US
contribute to therapists leaving that country? How can such a potentially negative impact
be minimized?
 Has the student been referred to such works as F. Kronenberg’s, Occupational Therapy
Without Borders to enhance use of professional nomenclature and awareness of social
justice issues, such as apartheid?
Language:
 What are the language requirements of the site?
 Is the student prepared to engage in language training, if required, in advance of
assignment to be sufficiently proficient by the starting date?
 Is there any reason not to proceed with the placement if the student is not proficient in the
language of the country, but is proficient in the language of a large segment of the
population served, and is, therefore acceptable to the site?
 Will the language in which supervision is documented be understood by both student and
fieldwork educator?
 Does the student or academic OT/OTA program recognize the value
(cognitive/connections) of being exposed to a new language?
Legal Considerations:
 Is the student aware that legal standards of the home country may not apply in the
country to which the student is to be assigned?
 Is the student likely to raise concerns about laws and rights that may only apply and/or
need to be posted in the home country?
 Does the student know that penalties for such violations as drug use may be much more
severe in the host country than in the home country?
 Is the student sufficiently astute/informed to realize that practice carried out in the host
country may well be beyond the scope of practice and supervision requirements of the
state to which the student will return?
Liability:
 What are the liability and risk management considerations that must be delineated and
agreed upon by institutional leadership, faculty, and fieldwork educators from both the
sending school and student prior to placement?
 Is the country considered a litigious society?
 Does the student’s liability insurance cover an international experience?
 Will the student be registered as such in the home educational institution while
completing a fieldwork placement outside of the country?
 Does the host agency provide liability coverage for students?
Respect:
 Does the student already demonstrate respect for people from different ethnic
backgrounds and for people of different ages and abilities?
 Is the student ready to respect the norms of the host country and the policies of the
receiving agency?
 Are there safety issues within the country or fieldwork site that may compromise the
student’s ability to complete fieldwork at that site?
 Does the student have the self sufficiency and emotional maturity needed to negotiate
unexpected situations that might be encountered?
 Has the student been prepared to “expect the unexpected?”
 Is the fieldwork site aware that the student may be out of his or her comfort zone in the
new setting?
 Is the student likely to engage in risky behaviors in the anticipated host environment?
 Is the fieldwork site located within a country of relative calm?
 What procedures are in place regarding crime, terrorism, disaster planning?
Valuing differences:
 Is the student committed to make diversity an advantage?
 Is the student eager for the learning experience offered by a different environment,
different people, different equipment, different treatment approaches, and more?
 Has the student read some of the OT-related articles regarding international experiences?
 Has the student read some of the OT-related articles regarding cultural sensitivity?
Resources:
American Journal of Occupational Therapy
Tips for traveling abroad (including safety), by the U.S. Government
Prepared by:
International Fieldwork Ad Hoc Committee for the Commission on Education (1/26/09).
Patricia Crist, PhD, OTR/L, FAOTA (Chair)—Duquesne University, PA
Naomi Greenberg, MPH, PhD, OTR—LaGuardia Community College, NY
Susan K. Meyers, EdD, OTR, Private Foundation, IN
Susan Mullholland MSc (rehab), BScOT, OT©—University of Alberta
Patty Stutz-Tanenbaum, MS, OTR—Colorado State University, CO
Pamela Richardson, PhD, OTR/L, FAOTA—San Jose University, CA
Debra Tupe, MS, OTR—Columbia University, NY
Neil Harvison, PhD, OTR/L—AOTA Staff
Emerging Leaders Development Program Participant
Juleen Rodakowski, OTD, OTR/L