Ethics and Law in Occupational Therapy Practice

CONTACT HOURS: 3

Copyright © 2021 Wild Iris Medical Education, Inc. All Rights Reserved.

BY: 

Kalyn M. Briggs, PhD, OTR/L; Persis Mary Hamilton, EdD, MSN, BSN, PHN, PMHN

LEARNING OUTCOME AND OBJECTIVES:  Upon completion of this course, you will be prepared to incorporate ethical principles and behaviors into the practice of occupational therapy. Specific learning objectives to address potential knowledge gaps include:

  • Identify the meaning of ethics and ethical theories.
  • Discuss the Core Values, Principles, and Standards of Conduct of the AOTA Occupational Therapy Code of Ethics.
  • Describe how civil and criminal laws apply to the practice of occupational therapy.

TABLE OF CONTENTS

  • What Are Ethics?
  • AOTA OT Code of Ethics
  • Legal Issues and OT Practice
  • Conclusion
  • Resources
  • References

WHAT ARE ETHICS?


Ethical action goes beyond rote compliance with principles and is a manifestation of moral character and mindful reflection. It is a commitment to benefit others, to virtuous practice of artistry and science, to genuinely good behaviors, and to noble acts of courage. Recognizing and resolving ethical issues is a systematic process that includes analyzing the complex dynamics of situations, weighing consequences, making reasoned decisions, taking action, and reflecting on outcomes (AOTA, 2020).

The terms laws and ethics are distinct from one another, although some individuals mistakenly assume they mean the same thing. In the United States, law refers to any rule that, if broken, “subjects the person(s) who break the rule to criminal punishment or civil liability” (The Free Dictionary, n.d.-a). Occupational therapists and occupational therapy assistants must practice according to the laws that govern their society as well as their occupational therapy practice.

Ethics refers to a system or set of moral principles that govern behavior, including job performance. Ethics includes beliefs about the “rightness” and “wrongness” of actions as well as the “goodness” and “badness” of motives and outcomes (The Free Dictionary, n.d.-b). Occupational therapists and occupational therapy assistants must practice according to the ethical principles of their profession as described in the AOTA Occupational Therapy Code of Ethics (see below).

Ethical Theories

In order to clarify questions around what people consider to be “right” or “good,” philosophers of ethics have generally sought to formulate and justify ethical theories. These theories are intended to explain the fundamental nature of that which is “good,” why it is “good,” and why the ethical principles most commonly used to evaluate human conduct follow (or do not follow) from these theories. Ethical theories may be presented for different purposes, as described in the examples below:

  • Teleological ethical theory, also called consequentialist theory, claims that it is the consequence, or end result, of an action that determines whether the action is right or wrong. The most common form of consequentialism is utilitarianism or social consequentialism, which holds that one should act so as to do the greatest good for the greatest number of people. A utilitarian may consider lying to be justified if it results in helping a patient.
  • Deontological ethical theory, or “duty ethics,” argues that it is the motivation, as opposed to the consequences of an action, that determines whether the action is right or wrong. For instance, unlike utilitarians, truth-telling may be considered a moral duty and lying to be wrong even if truth-telling may cause harm or lying would accomplish a great good.
  • Principlism is a widely applied ethical approach based on the four fundamental moral principles of autonomy, beneficence, nonmaleficence, and justice. It is not intended to be a general moral theory. Instead, principlism provides a framework of underlying values that can be applied to identify moral problems and aid in practical ethical decision-making.
    (Amer, 2019)
FUNDAMENTAL PRINCIPLES

Four fundamental ethical principles are generally accepted and applied to the practice of healthcare as a whole:

  • Autonomy refers to the ability of an individual to think, decide, and act upon one’s own initiative. It is the responsibility of healthcare providers to provide sufficient and accurate information to a patient to allow the patient to make informed decisions and to honor a patient’s decisions regarding their own healthcare even when a patient’s decision may diverge from what the healthcare team would choose.
  • Beneficence means working actively for the best interests of the patient. This principle highlights the general concept of doing good for others and, in the context of a provider-patient relationship, entrusts a healthcare provider with performing professional and clinical duties in a competent, caring manner that will benefit the patient.
  • Nonmaleficence means to do no harm to a patient. This may mean carefully weighing potential benefits against potential negative results and/or side effects that may potentially result from providing healthcare interventions.
  • Justice refers to a healthcare provider’s ethical responsibility to, insofar as possible, provide equal and impartial treatment to all patients in similar situations, regardless of a patient’s age, disability status, socioeconomic status, race, religion, gender identification, sexual orientation, or other background factors.
    (Beauchamp & Childress, 2019)

Ethical Dilemmas

An ethical dilemma is a conflict between choices that, no matter which choice is made, some ethical principle will be compromised. Resolution of ethical dilemmas requires careful evaluation of all the facts of a case, including applicable laws, consultation with all concerned parties, and appraisal of the decision makers’ ethical philosophies (Hegde, 2019).

In order to resolve an ethical dilemma in the best possible way, several steps should be taken. These include:

  • Gather all relevant data; include all options and opinions.
  • Identify the existence of an ethical issue. Such issues typically occur when dealing with “right vs. wrong” and “good vs. bad” concepts.
  • Identify the person(s) involved in the dilemma and their concerns, conflicts, and how they will be affected by decisions made.
  • Identify all options for the resolution of the ethical dilemma.
  • Analyze options and determine what solutions best facilitate resolution.
  • Determine a course of action.
  • Review how the involved persons feel about the proposed course of action.
  • Take action.
    (Mintz, 2019)