Ethical Decision Making in Occupational Therapy

Ethics, or the study of standards of conduct and moral judgment, is part of the branch of philosophy referred to as moral philosophy. The study of ethics includes a “systematic study of rules of conduct that is grounded in philosophical principles and theory.” In laymen's terms, ethics is a set of standards of what is morally right and what is morally wrong.

Recommended course: Ethics Issues and Decision Making in Occupational Therapy, 3rd Edition

Professional codes of ethics

Professional groups often create codes of ethics to define values and principles of professional conduct. These codes also provide guidelines for the resolution of complex problems. Healthcare professionals’ codes of ethics usually have four purposes:

1. Provide guidance regarding mandatory behavior expected of members while performing various roles and functions in the work setting.
2. State the rights of persons with whom members interact, such as clients, research participants, students, employees, colleagues, or the public at large.
3. Address ethical problems, issues, and dilemmas particular to the profession, such as when to initiate and terminate service.
4. Include provisions for enforcing the code. Enforcement may be subdivided into several categories depending on the perceived severity of the infraction of the code.

The Occupational Therapy Code of Ethics

The ethical principles that guide ethical action, behavior and attitudes for the occupational therapy profession are identified in the Occupational Therapy Code of Ethics. The American Occupational Therapy Association (AOTA, 2020) publishes this official document.

The Occupational Therapy Code of Ethics is a public document and is used to promote and maintain a high quality of conduct within the profession. The Code is designed to inform and protect current and potential consumers while safeguarding the integrity of the profession.

Although the Occupational Therapy Code of Ethics reflects current thinking, the code is reviewed every five years by the Ethics Commission (EC), a formative body of the AOTA. Updates are designed to clarify and expand the thinking and actions that occupational therapy personnel should provide to clients. These updates also ensure that occupational therapy knowledge, skills, and attitudes are being applied within the ethics standards adopted by society as reflected in current state and federal laws and regulations and institutional policies and procedures.

Ethical dilemmas in occupational therapy

Occupational therapists (OTs) and occupational therapy assistants (OTAs) frequently encounter ethical dilemmas that require moral judgment and ethical decision-making. All occupational therapy practitioners and students must abide by ethical standards, regardless of where or how they practice.

The Code serves two purposes:

• To provide “aspirational Core Values that guide occupational therapy personnel toward ethical courses of action in professional and volunteer roles” and
• To delineate “ethical Principles and enforceable Standards of Conduct that apply to AOTA members”

The Code includes six principles and seven standards of conduct that can be enforced and regulated by the application of the “Enforcement Procedures for the AOTA 2020 Occupational Therapy Code of Ethics.” This document offers members and the public the regulatory component as applied to AOTA members.

Additionally, state licensure laws may incorporate the Code in part or in whole and enforce it via the state regulatory board. The regulatory component then depends on the sanctions provided by the particular state licensure law. Sanctions that a legal entity (e.g., a state licensure board) may apply include requiring a person to:

• Attend continuing education courses
• Perform a specified number of community service hours
• Participate in a rehabilitation program for substance use
• Pay a monetary fine
• Refrain from practice for a certain length of time
• Permanently stop practicing as an occupational therapist (OT) or occupational therapy assistant (OTA)

None of these actions, however, can be applied by the AOTA Ethics Commission within its scope of power. The actions that the AOTA Ethics Commission may apply include reprimand, censure, probation of membership, suspension, and revocation of Association membership (AOTA, 2021).

Core values and ethical principles of occupational therapy

The seven core values discussed in the Occupational Therapy Code of Ethics include altruism, equality, freedom, justice, dignity, truth, and prudence.

The six ethical principles come in two distinct sets. The first set of four principles deals with morality and includes beneficence, nonmaleficence, autonomy, and justice. The final two principles concern professional-client relationships and include veracity and fidelity.

Finally, the Code of Ethics describes seven standards of conduct governing all OT professionals:

• Professional integrity, responsibility, and accountability
• Therapeutic relationships
• Documentation, reimbursement, and financial matters
• Service delivery
• Professional competence, education, supervision, and training
• Communication
• Professional civility

Navigating ethical problems as an occupational therapist

Navigating ethical problems can be complex. Authors and researchers Doherty and Purtilo (2016) suggest a six-step process for health professions to use when making an ethical decision. The steps are:

1. Gather relevant information or “get the story straight”
2. Identify the type of ethical problem
3. Use ethics theories or approaches to analyze the problem
4. Explore the practical alternatives
5. Complete the action
6. Evaluate the process and outcome

Although occupational therapy practitioners must learn about the principles and standards of ethics during their academic preparation, often it's not until real-world practice that these issues come to light. Occupational therapy students and practitioners should take the opportunity throughout their careers to examine the Occupational Therapy Code of Ethics in detail and explore the enforcement procedures used by the AOTA with its members. Continuous reflection on the ethical dimensions of practice is essential to continued competency.

This article was written by Elizabeth D. DeIuliis, OTD, OTR/L, CLA, FNAP.