ethical decision making

Ethical Decision-Making Overview

• Course Title: OCCU 5003: Dimensions of Professional Practice

• Institution: Dalhousie University

Course Outline

• Quick refresher on ethical values & principles

• Types of ethical situations

• Ethical decision-making

COTNS Code of Ethics: Respect

• Client-centered practice

  • Right to safe, competent, and ethical occupational therapy services

  • Diversity among clients; recognition of each as an individual

• Respect for Autonomy

  • Right to make personal choices

  • Honoring dignity and worth of each individual

• Collaboration and Communication

  • Determine meaning and purpose for the client

  • Practice effectively as a team member with clients and other professionals

COTNS Code of Ethics: Trust

• Honesty

  • Truthfulness as a cornerstone of trust

• Fairness

  • Justice and equity in all dealings

• Accountability

  • Responsibility for decisions, actions, professional competence, and judgment

• Transparency

  • Full disclosure to maintain integrity in relationships

COTC 2021 Ethical Guidelines

• E1.1: Respect governing laws, codes of ethics, rules, and regulations of occupational therapy

• E1.5: Respond to ethical dilemmas using ethical frameworks and client values

• E1.8: Obligation to respond to and report unethical behavior

Clinical Reasoning (Shell & Shell, 2008)

• Form Reasoning

  • Analyzing ethical dilemmas and generating alternative solutions

  • Focused on determining the 'right' action

• Ethical Reasoning

  • Involves understanding competing principles, risks, and benefits

• Interactive Reasoning

  • Building positive relationships with clients, including using praise and nonverbal communication

• Conditional Reasoning

  • Flexibly respond to changing conditions and anticipate client needs based on past experiences

Clinical Reasoning (Maruyama et al., 2021)

• Professional Ethics

  • Driven by a focus on 'what should be done' rather than 'what could be done'

  • Acknowledge complex issues and contradictions in clinical data

  • Includes ethical dilemma recognition, analysis, self-monitoring, and self-reflection

Six Types of Ethical Situations (Drolet, 2018)

• Ethical Issue

  • Compromise of at least one ethical value

• Ethical Uncertainty

  • Uncertainty about applicable ethical principles

• Ethical Dilemma

  • Clash between at least two important ethical values

• Ethical Temptation

  • Tension between an ethical value and interest

• Ethical Silence

  • Failure to recognize or discuss the ethical problem

• Ethical Distress

  • Barriers that impede ethical conduct

Ethical Concerns (Drolet, 2018)

• Societal Level

  • Concerns based on utilitarianism & deontologism

• Institutional Level

  • Similar to societal concerns

• Interpersonal Level

  • Concerns for others; applicable across all ethical theories

• Personal Level

  • Focused on virtue ethics and axiological ontology

Ethical Analysis (Drolet, 2018)

• Awareness of professional values to guide practice

• Use narrative approaches to respect client values and beliefs

• Analyze rights and duties to ensure dignity, autonomy, and freedom

• Assess consequences of options for maximal happiness and minimal suffering

Ten Steps of Ethical Reflection (Drolet, 2018)

1. Describe the situation to identify the ethical issue

2. Identify and assess moral reactions

3. List and verify main hypotheses of the ethical situation

4. Analyze main ethical issues using QET

5. Define options and consequences for all actors

6. Identify all relevant terms, phenomena, and values

7. Clarify terms and values

8. Prioritize terms and values

9. Make a justified decision with convincing arguments

10. Evaluate the decision and actions taken

Case Studies

• Case Example 1

  • Dilemma faced when functioning as both a client's agent and an injured party's advocate

  • Difficulty experienced in maintaining integrity with WSIB as the client while being honest with the injured client

• Case Example 2

  • OT at a teen center confronted with attendance issue of grounded teen

• Case Example 3

  • Working with a CVA patient requiring safety measures and restraint, articulating justifications for interventions

Next Class

• Topic: Revisiting Critical Thinking & Clinical Reasoning

• Institution: Dalhousie University