ETHICS IN OT PRACTICE

Every profession has ethical standards created to guide practice. AOTA has created Code of Ethics for all OT practitioners to adhere to. These standards provide structure for behavior, guidance for practitioners to resolve concerns, and communicates the commitment of the profession to providing ethical care to those we service.

ETHICS DEFINED 

The ethics of an organization or an individual is a complex system of interwoven beliefs and principles. The development of ethical beliefs is influenced by a number of factors:

• Experience
• Laws, rules and regulations of an industry or organization
• Family and friends
• Education
• Religious and spiritual belief system

Developing an ethical foundation requires the individual to reflect upon and analyze moral principles or standards of conduct, personal or professional. Ethics serve as a guide to an individual’s behavior and influences the decisions they make.

The AOTA Code of Ethics provides a code to structure the relationship between the client and the therapist. The code of ethics provides a foundation for expected behavior within the profession by providing a common set of values and principles to promote and maintain high standards within the profession.

Therapists may find themselves in challenging ethical situations which may place them in the position to make a decision to resolve the issue. It can be helpful to identify the type of situation in order to determine the best path. The therapist should examine the situation and look at which area of the AOTA Code of Ethics appears breached. It will also be necessary to identify the locus of authority, the primary decision maker in the situation.

Ethical Distress

This refers to situations which challenge how a practitioner maintains professional or personal integrity. It can be helpful to discuss the situation with a supervisor or mentor in order to clearly identify the situation and possible options for resolution.

Ethical Dilemma  

This refers to a situation where 2 or more ethical principles fail to match. This can cloud the identification of a clear path for resolutions. The best course of action may ultimately be driven by legal requirements or an organizational policy versus what the therapist may personally wish to do. The hierarchy of governing influences must be carefully examined.

http://www.authorstream.com/Presentation/benjatchison-1309505-ethics-and-values-of-occupational-therapy/

AOTA CODE of ETHICS

Principle 1: Beneficence    

This refers to the expectation therapists demonstrate a concern for the health and welfare of all clients. Each patient should be treated fairly and equitably. This principle addresses the expectation the therapist will advocate for the client’s needs. It promotes public health and safety and insures services are reasonably priced.

Principle 2: Non-maleficence    

Simply stated, therapists will not cause a client harm in any way, physically or emotionally.

Principle 3: Autonomy and Confidentiality   

This outlines the expectation the therapist will acknowledge the clients right to determine their care and has the right to refuse care. The therapist should routinely collaborate with the client and caregivers when identifying goals. The patient must be cautioned about potential risks, fees, and anticipated outcomes of service. The client can expect personal and medical information will be confidentially maintained.

Principle 4: Justice      

OTs will provide services to clients fairly and without regard to race, socioeconomic status, religion or culture. Therapist must accept the responsibility for educating the public about the value of OT services. 

Therapists are expected to comply with organizational rules, local, state, federal, and international laws. Also, therapists are expected to honor documents out out by AOTA which govern OT practice. Documentation about service provided must be accurate. Any report or evidence of professional development provided to maintain credentials or be in compliance with practice laws must be accurate.

Principle 5: Veracity    

The OT must accurately represent professional qualifications, education and training when supporting information is required. Therapists must identify is a potential conflict of interest exists. The therapist is viewed as responsible to their actions and maintaining public trust of the profession.

Principle 6: Fidelity    

Therapist must be fair, respectful and demonstrate integrity when interacting with colleagues and other professionals. The therapist must address breeches in confidentiality in matters related to staff and colleagues and report misconduct observed.

REGULATION for ETHICAL OT PRACTICE

There are a number of agencies which govern OT practice and all do so in different ways. Accurately identifying the ethical issue will help the therapist identify the best agency to contact when needing information. Agencies or statutes can be federal, state or professional regulating laws or bodies responsible for different aspects of OT service provision.

Federal Statutes

These statutes passed by Congress can be enforced in the federal court system and violation may result in fines, injunctions, or prison time. Some statutes affecting OT include:

HIPAA

IDEA

ADA

Social Security Amendments

State Statutes

These have been passed by individual state legislatures and will vary from state to state. The state’s OT practice act is the most significant statute affecting OT practice within a particular state. Therapist moving or practicing in multiple states must be familiar with the scope of practice guidelines and licensure requirements in each state. The state’s licensure board carries out the task of implementing the licensure laws and regulation and they possess the authority to discipline members if the public is determined to be at risk.

Professional Regulatory Bodies

AOTA

Possess jurisdiction over members only. Disciplinary actions are reported to NBCOT and state agencies. The Standards of Ethics Commission (SEC) is responsible for informing and educating members about current ethical issues, upholding practice and education standards, monitoring member behavior and reviewing allegations of unethical conduct.

When a complaint is filed, the SEC initiates an investigation. If found guilty, sanctions will be imposed:

Reprimand: Formal expression of disapproval communicated privately in a letter from the Chairperson of the SEC. It is not disclosed to other regulatory agencies. 

Censure: Formal expression of disapproval which is public

Membership probation: Could be the need of the practitioner to meet stated terms, suspension for a specified period of time, or revocation of membership permanently.

ACOTE

State licensure requires practitioners to complete the academic and fieldwork requirements of an ACOTE accredited program. ACOTE sets the standards in which all OT programs must comply.

NBCOT

This organization has jurisdiction over all certified and eligible-for-certification practitioners. Continuing education is required in order to maintain certification (COTA) or registration (OTR).

State Licensure Board

The board has an established disciplinary process designed to protect the public from harm. Possible sanctions include:

• Fines                        
• Order of abatement or correction within a designated time frame
• Public censure            
• Temporary suspension of practice privileges
• Permanent prohibition from practice in the state

SOLVING ETHICAL PROBLEMS

Now that you have become well acquainted with the ethical principles of OT, let’s look at a simple way to solve potentially complex ethical situations. It is always a good idea to discuss the situation with someone informed and trustworthy prior to taking action.

Organizations often have policies and an identified chain of command for addressing Ethical concerns. Examining these policies may help guide you. Some organizations have anonymous tip-lines or hot lines to report suspected abuse. Gather your facts first. If you still have doubt about whether to report a situation, it typically means you need more information. BE careful your motivation is not personal and the interest of the client remain at the core of any action you may pursue.

1. Gather relevant facts about the situation
2. Describe the clinical, contextual, individual preferences influencing the situation
3. Identify the type of ethical situation – distress, dilemma, locus of authority
4. Identify the AOTA ethical principle involved (beneficence, non-maleficence, etc.)
5. Identify professional duties outlined in the Code of Ethics and required conduct of all involved
6. Explore parties involved, alternatives, desired outcomes and consequences
7. Identify facts, laws, resources and wishes of those involved
8. Complete the action based on identified policy outlining steps required
9. Evaluate the process and outcomes

      FAQs About Ethics 

SHARE YOUR EXPERIENCE

Provide specific examples of how you are seeing the AOTA Code of Ethics and Standards of Practice upheld in the clinical setting you are currently in. 

• Speak to your supervisor and ask them to describe an ethical situation they experienced and how it was ultimately resolved. Share the story here. These stories can later help you identify alternative options in situations you may encounter later in your career.

• Discuss the systems, informal and formal, in place for resolving conflict affecting ethical OT practice in the clinical site you are in.

• Discuss a situation where you needed to utilize concepts included in the AOTA Code of Ethics and/or Standards of Practice or some organizational ethical policy to make a difficult choice or decision related to patient care or a challenging situation with another professional or caregiver. It may have been a situation where there was "no good answer" but a decision had to be made.