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

2. “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

3. 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.

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

16. 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

17. 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

18. 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

19. 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