INTRO TO OT - (Chapter 8) Practicing Legally and Ethically

MORALS

• character and behavior from the point of view of right and wrong

• develop as a result of background, values, religious beliefs, and

  the society in which a person lives

• practitioners bring their individual morals to situations and those

  morals may or may not be in agreement with the client's morals

• decisions may or may not agree with the practitioner's morals;

  rather, decisions are based upon ethics

• Practitioners are required to comply with professional ethics and

  legal mandates.

ETHICS

• study and philosophy of human conduct

• “a systematic reflection on and an analysis of morals.”

• guide how a person behaves and makes decisions so that the besto or “right” conduct is carried out

LAW

• “a binding custom or practice of a community: a rule of conduct

  or action prescribed or formally recognized as binding or

  enforced by a controlling authority.”

• established by an act of the federal or state legislature

• intended to protect citizens from unsafe practice

PRACTICING ETHICALLY

• Some situations are easy to resolve, whereas others may

  challenge one's decision-making abilities

• Clinicians frequently rely on their own values and morals when

  deciding a course of action

• professional decision-making relies on a systematic ethical

  problem-solving process

CLINICAL REASONING

• understanding the client's diagnoses, strengths, weaknesses, prognosis, and goals

• develop and provide intervention to address goals and make

  necessary adaptations

• requires problem-solving and professional judgment

• it improves with experience, reflection, and critical analysis

• Practitioners use clinical reasoning along with morals and ethics

  when making professional decisions

CODE OF ETHICS

• provides direction to members of a profession for mandatory

  behavior and protects the rights of clients, subjects, their

  significant others, and the general public

• provide guidelines for making correct or proper choices and

  decisions of health care practice in the field

• meant to inspire professional conduct for quality and empathetic

  occupational therapy while respecting the diversity of clients

• based upon the core values of the profession

AMERICAN OCCUPATIONAL THERAPY ASSOCIATION CODEO OF ETHICS

• initially adopted by AOTA's Representative Assembly in April 1977

• provides guidelines to practitioners to help them recognize and

  resolve ethical dilemmas, to practice at the expected standard

  using guiding principles, and to educate the public

1. BENEFICENCE

2. NONMALEFICENCE

3. AUTONOMY AND CONFIDENTIALITY

4. SOCIAL JUSTICE

5. PRCEDURAL JUSTICE

6. VERACITY

7. FIDELITY

OCCUPATIONAL THERAPY CODE OF ETHICS

BENEFICENCE

• OT practitioner will contribute to the good health and welfare of

  the client

• (1) treat each client fairly and equitably

  (2) advocate for recipients to obtain needed services

  (3) promote public health and safety and well-being

  (4) charge fees that are reasonable and commensurate with the

  services provided

NONMALEFICENCE

• practitioner should not inflict harm on the client

• maintain therapeutic relationships that do not exploit clients physically, emotionally, psychologically, socially, sexually, or financially

• it is the practitioner's responsibility to address concerns and foresee possible harmful situations so that harm can be avoided

• practitioners avoid any relationships, activities, or undue

AUTONOMY AND CONFIDENTIALITY

• client will determine how and to whom information may be shared

• respect a client's right to refuse treatment, and it protects all privileged communication

• (1) collaborates with clients and caregivers to determine goals

  (2) informs clients of the nature, possible risks, and outcomes of

  services

  (3) receives informed consent for services

  (4) respects a client's decision to refuse treatment

  (5) maintains confidentiality concerning information

Autonomy

is the freedom to decide and the freedom to act

Confidentiality

refers to the expectation that information shared

by the client with the OT practitioner, either directly or through

written or electronic forms, will be kept private and shared only

with those directly involved with the intervention (under

conditions expected by the client)

INFORMED CONSENT

• “knowledgeable and voluntary agreement by which a client

  undergoes intervention that is in accord with the patient's values

  and preferences”

• clients have the right to refuse intervention and the right to be

  made aware of the risks, benefits, and cost of occupational

  therapy intervention

SOCIAL JUSTICE

• practitioners provide services in a fair and equitable manner to all

• individuals and groups should receive fair treatment and be afforded the same opportunities

• practitioners must advocate for their clients and provide opportunities for their clients to participate equally in occupations

• take responsibility to educating the public and society about the value of occupational therapy services.

PRCEDURAL JUSTICE

• practitioners are obligated to comply with the laws and regulations that guide the profession

• practitioner must be aware of and follow federal, state, and local laws, as well as institutional policies

• practitioners must accurately report and document information related to professional activities

VERACITY

• duty of the health care professional to tell the truth

• practitioners must accurately represent their qualifications, education, training, and competence

• may not use any form of false advertising or exaggerated claims

• practitioner must disclose instances that pose actual or potential conflicts of interest

• practitioner must accept responsibility for actions that reduce the public's trust in occupational therapy services

FIDELITY

• faithfulness, in professional relationships

• interactions between an OT practitioner and his or her colleagues and other professionals

• maintaining confidentiality in matters related to colleagues and staff

• accurately representing qualifications, views, and findings of colleagues;

• reporting any misconduct to the appropriate entity are considered part of fidelity

1. ETHICAL DISTRESS

2. ETHICAL DILLEMA

3. LOCUS OF AUTHORITY

SOLVING ETHICAL PROBLEMS

ETHICAL DISTRESS

challenge how a practitioner maintains his or her integrity or the

integrity of the profession

ETHICAL DILLEMA

two or more ethical principles collide with one another, making

it difficult to determine the best action

LOCUS OF AUTHORITY

require decisions about who should be the primary

decision-maker

PRACTICING LEGALLY

At both the state and federal levels, there are different types of

laws that govern certain aspects of occupational therapy practice

STATUTES

• laws that are enacted by the legislative branch of a government

• there are federal and state statute

• federal Congress or state legislature votes to pass a law, which then is assigned to an agenc

• agency, or a designated board, follows up with the development of regulations to implement and enforce the law

REGULATIONS

• how the intent of the law will be carried out

• we discuss both statutes and regulations that affect the practice of occupational therapy

FEDERAL STATUTES

• can be enforced through the federal court systems

• violating a federal statute may result in fines, injunctions, or prison time

Health Insurance Portability and Accountability Act (HIPAA)

established national standards for electronic health care

transactions and addressed the security and privacy of health

care data

Individuals with Disabilities Education Act (IDEA)

requires public schools to make available to all eligible children

with disabilities a free, appropriate public education in the least

restrictive environment appropriate to their individual needs.

Americans with Disabilities Act (ADA)

provides protection from discrimination on the basis of disability

Social Security Amendments of 1965

• established, among other provisions, the foundation for the Medicare and Medicaid programs.

• Medicare is a federally subsidized health insurance program for individuals 65 and older

• Medicaid is a joint federal- and state-funded program that provides health care services to the poor.

Medicare

a federally subsidized health insurance program for individuals 65 and older

Medicaid

a joint federal- and state-funded program that provides health care services to the poor.

STATE STATUTES

• passed by state legislatures

• regulations will vary from state to state

• a state has a family or civil code, a criminal code, a welfare code, and a probate code, in addition to many other codes dealing with a wide variety of topics

• permitted by the federal constitution to regulate areas such as education, insurance (private and public), and licensing

• state statutes may affect the practice of occupational therapy through regulation of the insurance industry, including health maintenance organizations, workers’ compensation insurance programs, and health care services for the indigent

• most significant statutes affecting occupational therapy practice is the state occupational therapy practice act

MANDATORY REPORTING

• requirement that certain professionals, including health care providers, report suspected child abuse

• A health care provider who fails to report suspected abuse may be criminally liable

STATE REGULATION OF OCCUPATIONAL THERAPY

• State regulation of occupational therapy practice has been in place since the 1970s

• licensure, statutory certification laws, registration, and trademark laws

• regulated through District of Columbia, Puerto Rico, and Guam

• primary purpose of regulation is to protect the consumer from practitioners who are unqualified or unscrupulous

• a person may not use the title of or proclaim to be certified or registered unless he or she has met specific entry-level requirements

LICENSURE

• most stringent form of regulation

• “the process by which an agency of government grants permission to an individual to engage in a given occupation upon finding that the applicant has attained the minimal degree of competence required to ensure that the public health, safety, and welfare will be reasonably protected.”

STATE LICENSURE

• one way to ensure the public that the person delivering services has obtained a degree of competency required by the profession and has permission to engage in that service

• it is illegal to offer occupational therapy services without a license

• licensure laws also define the scope of practice of a profession and are often referred to as practice acts

SCOPE OF PRACTICE

• legal definition of occupational therapy's domain of practice

• another step toward ensuring consumer protection

• defends occupational therapy from challenges of other professions that may question the qualifications of practitioners to provide particular services or that may infringe upon occupational therapy's scope of practice

DISCIPLINARY PROCESSES

• The Ethics Commission (EC) of AOTA ensures compliance with the Code of Ethics, and it establishes and maintains enforcement procedures

• EC conducts a preliminary assessment and determines if there is sufficient ground to carry the complaint forward to a full investigation.

• member is found to have committed an ethical violation

• the following disciplinary sanctions is imposed: reprimand, censure, probation of membership subject to terms, membership suspension, or revocation

• It is the responsibility of the licensure board to protect the public from direct or potential harm that may be caused by unqualified or incompetent practitioners

• Disciplinary actions that could be taken against the practitioner include public censure, suspension, or revocation of licensure or practice privileges.