Chapter 12 Ethics – Key Terms (AOTA Code of Ethics)

Learning Objectives and Key Concepts

• After studying this chapter, readers will be able to:
  • Explain the meaning and purpose of the AOTA Occupational Therapy Code of Ethics (AOTA, 2015) and how it impacts your role as an occupational therapy assistant.
  • Understand the differences and similarities between ethical reasoning, actions, and behaviors and how they influence the profession.
  • Become familiar with the $6$ principles of the Occupational Therapy Code of Ethics (AOTA, 2015) and articulate the meaning of each as it applies to clinical practice as an occupational therapy assistant.

Ethics: Definitions and Foundational Concepts

• Ethics defined as “the study of standards of conduct and moral judgment” (Guralnik, 1986, p. 481).
• Ethics includes consideration of: Right versus wrong, justice, equality, free will, and responsibility (Bloom, 1994, p. 52).
• Ethical principles consist of four standards:
  • Prudence — choosing the right means
  • Temperateness — acting in moderation
  • Courage — being willing to do what is right
  • Justice — treating others with respect and honor
    (Wagenfeld & Hsi, 2003, p. 47)

Ethical Principles Specific to OT Practice

• Universalism
• Being nonbiased in how we treat and interact with others
• Not being solely driven by money, yet always providing the best possible treatment
• Cooperation

Ethical Action and Ethical Reasoning

• Ethical action: “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” (AOTA, 2015, p. 1, paragraph 3).
• Ethical reasoning: Internal debate about right and wrong conduct.

Ethical Practice Standards and Continuing Competence

• Ethical practice is one of the standards in AOTA’s Standards for Continuing Competence (2015).
• The OT practitioner must:
  • Understand and adhere to all laws and the profession’s Code of Ethics Standards
  • Use the profession’s core values and ethical situations to understand complex situations
  • Make and defend decisions based on ethical reasoning
  • Integrate varying perspectives in the ethics of clinical practice (Standards for Continuing Competence, 2010)

Ethical Dilemmas: Where to Go for Help (cont.)

• AOTA is the first-line resource for ethical concerns.
• Commission on Ethics (EC): reviews ethics complaints that involve occupational therapy.
• Supervisor
• Human resources department
• National Board for Certification of Occupational Therapy (NBCOT)
• Local and state licensing or regulatory boards

The OT Practitioner Responsibility in Dilemmas

• Face the issue head on.
• Report to the appropriate personnel for immediate attention.

Code of Ethics (cont.): History and Purpose

• The Occupational Therapy Code of Ethics Standards were originally drafted in $1998$; the current version was published in $2015$.
• It is an: “Official document and a public statement tailored to address the most prevalent ethical concerns of the occupational therapy profession. It should be applied to all areas of occupational therapy and shared with relevant stakeholders to promote ethical conduct” (AOTA, 2015, p. 1, paragraph 2).

Core Concepts and Core Values (Seven) in OT Practice

• OT remains grounded in seven core concepts, laid out in Core Values and Attitudes of Occupational Therapy Practice:
  • Altruism
  • Equality
  • Freedom
  • Justice
  • Dignity
  • Truth
  • Prudence

Code of Ethics Standards: Foundations and Aspirational Nature

• The Occupational Therapy Code of Ethics Standards have:
  • A historical foundation in ethical reasoning
  • Deeply rooted in ethical action
• Aspirational, not legal in intent:
  • Designed to protect the public
  • Reinforce the public’s confidence in the profession
• Not designed to resolve private business disputes or legal disputes
• AOTA has no legal authority over its members (AOTA is a voluntary membership agency); NBCOT regulates practice, credentialing, and practitioner eligibility

Legal Authorities and Governance

• Legal authorities responsible for the investigation and prosecution of ethical misconduct: state, regional, and territorial boards

The Six Moral Principles and Standards of the Code of Ethics

• Beneficence
• Nonmaleficence
• Autonomy
• Justice
• Veracity
• Fidelity

Beneficence (cont.)

• OT personnel shall demonstrate a concern for the well-being and safety of the recipients of their services (AOTA, 2015, p. 2, paragraph 5).
• Actions of beneficence include: actions intended to help others and to prevent or remove harm; must explain to clients the risks and benefits of treatment procedures
• Ten identified actions of beneficence in the Code of Ethics

Nonmaleficence

• OT personnel shall refrain from actions that cause harm (AOTA, 2015, p. 3, paragraph 2).
• Do no harm under any circumstances.
• Ten identified actions of nonmaleficence in the Code of Ethics Standards

Autonomy

• OT personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent (AOTA, 2015, p. 4, paragraph 2).
• Within accepted standards of care, follow the client’s wishes in terms of the direction of care
• Maintain and protect client confidentiality at all times: includes students, research subjects, and all who seek information about occupational therapy services
• Ten identified actions of autonomy in the Code and Ethics

Justice

• OT personnel shall promote fairness and objectivity in the provision of occupational therapy services (AOTA, 2015, p. 5, paragraph 2).
• Goes beyond simply following the law; requires equitable treatment and benefits for all people regardless of challenges they face
• Sixteen identified actions of justice in the Code of Ethics

Veracity

• OT personnel shall provide comprehensive, accurate and objective information when representing the profession (AOTA, 2015, p. 7, paragraph 1).
• Veracity includes truthfulness, candor, honesty, transparency, and avoiding deception
• Balanced with other ethical principles, cultural sensitivity, organizational policies and procedures
• Ten identified actions of veracity in the Code of Ethics

Fidelity

• OT personnel shall treat colleagues and other professionals with respect, fairness, discretion, and integrity (AOTA, 2015, p. 8, paragraph 1).
• Applies most to maintaining relationships and balancing duties with all people and organizations encountered
• Thirteen identified actions of fidelity in the Code of Ethics

Enforcement Procedures for the Code and Ethics Standards (cont.)

• Breach leads to enforcement procedures to maintain compliance with the Occupational Therapy Code of Ethics; purpose is objectivity and fairness to all concerned
• If AOTA member, obligated to:
  • Adhere to the Occupational Therapy Code of Ethics Standards
  • Cooperate with Enforcement Procedures

AOTA Enforcement Committee (EC) and Its Focus

• EC focuses on seven issues (cont.):
  • Professional responsibility and other processes
  • Jurisdiction
  • Disciplinary actions/sanctions (pursuing a complaint) with subtypes including:
  • Reprimand — nondisclosable private letter from the EC Chairperson
  • Censure
  • Probation of Membership (subject to terms)
  • Suspension of AOTA membership for a set period
  • Revocation of AOTA membership permanently
  • Educative letters
  • Advisory opinions
  • Rules of evidence
  • Confidentiality and disclosure

Complaint Filing and Investigation Timeline

• Anyone can file a complaint; you do not have to be within AOTA
• EC has $90$ days to review and investigate and determine whether further action is to be taken; notify involved parties

Review, Disciplinary Council, and Appeals

• Respondent under review may appear before a disciplinary council to respond to or refute charges or sanctions
• An appeals process exists for AOTA members after the review and decision process

Final Decisions and Records

• Final decisions are put in writing and sent via certified delivery to all parties
• Records and reports are kept in the AOTA Ethics Office for $5$ years
• Sanctions and other disciplinary actions are publicized after the appeals process is completed

Effects of Enforcement Actions

• Actions taken by the EC do not impact a practitioner’s right to practice, but do impact membership in AOTA
• NBCOT has the authority to revoke an occupational therapy practitioner’s credentials