In-Class Activity 3: Ethics

Activity Overview

This in-class activity (ICA) is the third of four that you will turn in for credit. It is designed to
introduce you to the ethical values and principles that guide occupational therapy practice. You
will receive full credit for this activity if turned in in its entirety. If you do not turn it in, do not
turn it in on time, or turn it in incomplete, then you will receive a score of 0. I will provide
general feedback on your responses and upload them to Moodle. I will not be providing feedback
on the quality of your writing.

Learning Objectives

By the end of this activity, you will (1) understand the profession’s ethical values and principles;
(2) learn how to identify and navigate ethical dilemmas; and (3) use the 6-step process for ethical
decision making to resolve an ethical dilemma.

ACOTE Standards

Demonstrate knowledge of the American Occupational Therapy Association (AOTA)

Occupational Therapy Code of Ethics and AOTA Standards of Practice and use them as a guide
for ethical decision making in professional interactions, client interventions, employment
settings, and when confronted with personal and organizational ethical conflicts. (B.7.1)

Instructions

Respond to the following prompts:

1) You are working with an individual who experienced a left CVA resulting in right-sided
movement problems. This individual requires a lot of assistance at home with all basic daily
activities, but they have good potential to benefit from occupational therapy services to become
more independent. This client’s insurance only covers the first 30 minutes of their therapy
sessions. Meaning, if 120 minutes of therapy are provided, only 30 minutes of them will be
reimbursed. Due to this client’s clinical presentation, they need more than 30 minutes of
treatment per session. However, because of their insurance’s poor reimbursement structure, your
employer tells you to keep all treatments with this individual to 30 minutes.

a. What is one core value that is at stake and why?

A core value that is at stake is justice. Justice means that everyone is able to get the same
treatment regardless of who they are. Only letting the individual have 30 mins of treatment
compared to the full 120 mins they need, is unethical. The Code of Ethics says “all members can
function, flourish, and live a satisfactory life regard- less of age, gender identity, sexual
orientation, race, religion, origin, socioeconomic status, degree of ability, or any other status or
attributes”.
b. When attempting to understand and navigate this situation, what principle will best assist you
with making sound ethical decisions and why?

A good principle to follow would be Fidelity. Fidelity states that one should treat clients
with respect, fairness, discretion, and integrity. This will help me because I will be treating my
client freely despite their insurance. I would try my best to get them the time of 120 mins. It is
my duty to fight for everyone’s rights. I would be fighting for their right of medical services.

c. What standards of conduct may be involved in this situation and why?

One standard of conduct that may be involved are documentation, reimbursement, and
financial matters. This would be involved because it is a case of financial matters. Their
insurance is not able to be billed for the full 120 mins, so the employer tells me to do something
unethical.

Another standard of conduct that may involved is professional integrity, responsibility,

and accountability. I would need to check if these practices were lawful. I have never
encountered a situation like this, but if was unlawful I would report the employer.

2) You are working in a privately-owned neurological rehabilitation center with an

interprofessional team composed of occupational, physical, and speech therapists, education
specialists, athletic trainers, behavior analysts, case managers, and physicians. There are also
aides who assist with the daily treatments of the clients; clients are typically complex in their
presentation (i.e., they have a lot of physical, behavioral, and cognitive health problems). All
professionals wear identification badges that have their names but not their profession identified.
The aides on the other hand, are identified as Neurological Rehabilitation Specialists.

a. What is one core value that is at stake and why?

A core value that is at stake is dignity. The uniqueness of each profession is not being
shown here. Also, the aide being portrayed as a Neurological Rehabilitation Specialist is
misleading because they are not a specialist. Everyone should have profession listed so clients
know who to direct their questions and know who is providing them care.

b. When attempting to understand and navigate this situation, what principle will best

assist you with making sound ethical decisions and why?

The principle that will best help me make ethical decisions is Veracity. I don’t believe we
are providing accurate care. If we are not properly donning our nametags with the description of
what we do, we are not helping the client be their best self. The client may start asking PT
questions about OT. While they may have some sense of what the answer is, they are not the
correct ones to identify it. A big part is communication as well. We need to be clear when talking
to our clients.
c. What standards of conduct may be involved in this situation and why?

Standards of conduct that may be involved are Communication and Professional

competence. Professional competence because how does the team interact with each other if they
aren’t sure of their roles. One may hold more importance in their role, or the client may think one
is more important. They may not know how to properly do their job. Communication plays in to
how the client interacts with their practitioner. They may not want to talk to certain people
because they’re not sure of their role.

3) You are working with an older adult in an inpatient facility who has a terminal health
condition. This client has low energy, depression, and is generally deconditioned due to lack of
activity. In addition, they often refuse therapy because of feelings of depression, poor timing of
therapy visits, and lack of interest in the therapeutic activities the other therapists are offering.
Many of the therapists do not pay much attention to this client or put much energy into trying to
engage them in therapy because of the frequent refusals.

a. What is one core value that is at stake and why?

One core value that is at stake is altruism. Altruism is the unselfish concern for the
welfare of people. These therapists are being selfish because they are thinking about themselves.
They don’t take on that client so they don’t have to deal with them. They are putting their needs
above the client, but the client’s needs should always come first. Just because the client has
denied these services in the past, doesn’t mean they don’t want them today.

b. When attempting to understand and navigate this situation, what principle will best assist you
with making sound ethical decisions and why?

The best principle is beneficence. Beneficence is concern for the well-being and safety of
persons. One of the concepts is prevent harm. By letting the client be immobile, that is hurting
their quality of life. Life is based around movements, if they’re just sitting there every day, that’s
not good for them. It is also about being kind. It just takes one therapist that keeps working on
them until they thrive.

c. What standards of conduct may be involved in this situation and why?

Standards of conduct that may be involved are therapeutic relationships and service
delivery. For therapeutic relations it needs to be collaborative. So you and the client should both
be working on what you want to do. Because the client is depressed, that might hinder their will
to do things. It’s good to be a motivator and get them out of bed when they don’t want to.
Service delivery would be affected because the OT is not providing an adequate level of
intervention. The therapists are ignoring the client instead of helping them. Therefore, they are
not implementing a intervention.
4) You are working with a young adult client in a skilled nursing facility. This client has been
working with the occupational therapy assistant for several days. When you, the supervising
occupational therapist, check in with the client to see how therapy has been going, they tell you
that the assistant spends about 20 minutes with them before leaving and uses that time to chat
about daily events and do a few upper body resistance band exercises while seated. As the
supervising therapist who wrote this client’s plan of care and reviews the assistant’s daily notes,
you have concerns about what the client has told you, especially because the assistant is billing
for 60 minutes of treatment time.

a. Use the 6-step process for ethical reasoning to navigate this situation. For steps 1-5, use the
“Considerations” column to inform the process. For step 6, write a personal reflection addressing
the following:

1. Get the story straight:

 What happened: The assistant was billing for treatment time they did not give. The OT
assistant is involved. I heard it, so it may not be true.
 If client is involved: Diagnosis is not provided, but they do upper body resistance and
exercises while seated. So it may have to do with upper body. Client is aware that
something wrong is going on. Quality of life is going down because proper care is not
being provided. This is occurring in a SNF. Client has opportunity to talk to others but
has rightly come to me.

2. Identify the type of ethical problem:

 Dilemma/ ethical barrier: Truth. Truth means that the OTA is in all situations faithful to
facts reality. Per the client, the OTA is not being truthful. Although they may be wrong, I
don’t believe the client would have a reason to lie. But, I would check with the OTA
what is going on for their side of the story.
 Moral obligation: It is my obligation to find out what happened because the client came
to me. The moral agent is finding out the truth.

3. Use ethics theories or approaches to analyze the problem:

 Ethical values and principles: As stated earlier, truth is an ethical value. A principle is
fidelity. This means the OTA should treat the client with respect. They are not treating
them with respect if they are not providing full services.

4. Explore the practical alternatives:

 Review all options:

o Talk to the OTA
o Talk with the client again to see if their story is straight
o Talk with both the client and the OTA to assess their relationship
o Try a different OTA for the client
o Fire the OTA after assessing the situation
 o Assess other notes for different clients the OTA has worked with
 Talk to these other clients

5. Complete the action:

I will talk with the client again and talk with the OTA separately. I will see who is being
truthful. I will maybe have the client and OTA talk together to see if they can reach an
agreement. I would go and interview other clients the OTA worked with to see if they
have similar stories. If it turns out the OTA was not billing properly, I would let them go.
If it turns out the client was lying, I would try to put them with another OTA and keep
monitoring the situation. I could also sit in on a session with both of them to see what the
OTA does.

6. Reflect

i. How did it make you feel knowing that the situation described above is a true story? How does
it make you feel knowing that some therapists and assistants bill for services that were never
provided?

ii. What strengths do you possess that would support your ability to effectively navigate ethical
dilemmas?

iii. What weaknesses do you possess that would hinder your ability to effectively navigate ethical
dilemmas and what could you do to improve in these areas?

It would make me feel mad to know the situation is true and makes me mad that they bill
for this. They are being unethical and this could be grounds for termination. When I was
shadowing an OTA, she did similar stuff. They talked for most of the session and did therapy for
a little bit of it. I did not like shadowing her. The strengths I possess are knowing ethical core
values, principles, and standards of conduct. Weaknesses I may possess are biases towards the
offenders. We may be my friends and it might be hard to navigating things when we are close. I
can improve by staying professional with everyone and not bringing emotions into it. I also find
it hard to stand up to people. I may find it hard to bring up this topic because it makes me
uncomfortable. I can combat this by learning how to speak up and being more confident.