Chapter 8: Practicing Legally and Ethically

Objectives

  • Understand the purpose of a code of ethics.

  • Identify the six principles in the Occupational Therapy Code of Ethics.

  • Describe the function of the Ethics Commission.

  • Outline the steps to ethical decision making.

  • Distinguish ethical and legal behavior.

  • Explain the purpose and implementation of state laws regulating occupational therapy.

  • Describe the disciplinary processes developed by state regulatory boards and the professional association.

  • Discuss the similarities and differences of morals, ethics, and laws and their connection to the practice of occupational therapy.

Key Terms

  • autonomy

  • beneficence

  • professional reasoning

  • code of ethics

  • confidentiality

  • ethical dilemma

  • ethical distress

  • ethics

  • fidelity

  • informed consent

  • justice

  • law

  • licensure

  • locus of authority

  • mandatory reporting

  • morals

  • nonmaleficence

  • regulations

  • statutes

  • veracity

Practicing Ethically

  • Work Environment:

    • Occupational Therapy (OT) practitioners regularly encounter situations requiring them to balance various alternatives and make decisions leading to appropriate actions.

    • It is essential for clinicians to reflect on their values, beliefs, and attitudes to guide decision-making effectively.

    • To maximize positive outcomes, OT practitioners should apply a systematic ethical problem-solving process.

Solving Ethical Problems

  • General Steps to Resolve Ethical Problems (Doherty, 2020):

    1. Gather all the relevant facts about the situation.

    2. Identify the type of ethical problem.

    3. Clarify professional duties in this situation as outlined in the Code of Ethics.

    4. Explore alternatives, considering desired outcomes and consequences of actions.

    5. Decide and complete the action.

    6. Evaluate the process and the outcome.

American Occupational Therapy Association Code of Ethics

  • Principle 1: Beneficence

    • Definition: Act in the best interest of clients to promote their well-being.

    • This principle calls for actions that provide benefit.

  • Principle 2: Nonmaleficence

    • Definition: Duty to do no harm.

    • Practitioners must avoid actions that may cause harm to clients.

  • Principle 3: Autonomy

    • Definition: Respect for the client's right to make informed decisions about their care.

    • Emphasizes the importance of informed consent.

  • Principle 4: Justice

    • Definition: Fair and equitable treatment of clients, ensuring access to services and resources.

  • Principle 5: Veracity

    • Definition: Obligation to provide truthful information.

  • Principle 6: Fidelity

    • Definition: Commitment to the duties, responsibilities, and ethics of the profession.

Practicing Legally

  • Statutes and Regulations:

    • Statutes: Laws enacted by the legislative branch of a government.

    • Regulations: Detailed directives that specify how statutes are implemented and enforced.

    • Both statutes and regulations significantly impact the practice of OT.

Federal Statutes

  • Definition: Laws passed by Congress that apply to all states.

  • Enforcement: These statutes can be enforced within federal court systems.

  • Consequences of Violation: Violating a federal statute can lead to fines, injunctions, or imprisonment.

State Statutes

  • Definition: Laws passed by state legislatures, which can vary between states.

  • Categories of Codes:

    • Family or civil code

    • Criminal code

    • Welfare code

    • Probate code

    • Additional codes governing diverse topics

  • Regulatory Authority: States are permitted to regulate aspects like education, insurance, and licensing, influencing OT practice, particularly concerning regulations related to health services.

State Regulation of Occupational Therapy

  • Licensure Definition:

    • “The process by which a government agency 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.” (Davis-Becker & Buckendal, 2017)

Interstate Professional Licensing

  • Overview: AOTA, NBCOT, and the Council of State Governments (CSG) collaborated to establish an interstate professional licensing compact for OT.

  • Implementation Date: Virginia was the first state to enact this compact, which is set to begin in 2024, with nine other states also joining.

  • Scope: The compact enables OT practitioners to practice across state lines without altering individual state OT practice acts or scopes of practice.

Disciplinary Processes

  • Authority: AOTA oversees complaints against members suspected of unethical conduct.

  • Sanctions Imposed for Ethical Violations:

    • Reprimand

    • Censure

    • Probation of membership, subject to terms

    • Membership suspension

    • Revocation of membership in AOTA (AOTA, 2021)

  • Communication: AOTA coordinates with NBCOT and state regulatory boards regarding disciplinary actions against OT practitioners.

Ethics Commission

  • Purpose: Enforces the principles outlined in the Code of Ethics.

  • Principles:

    • Beneficence

    • Nonmaleficence

    • Autonomy

    • Justice

    • Veracity

    • Fidelity

  • Decision-Making: Adopting ethical decision-making processes enables practitioners to make sound professional choices.

  • Regulatory Responsibility: OT practitioners must understand and adhere to both ethical standards and legal regulations governing practice.

  • Rights and Responsibilities: While laws and regulations confer rights and protections to OT practitioners, they also impose responsibilities and limit practices according to regulatory frameworks.