2313AHS

Tutorial

ETHICAL REASONING
Objectives
• To explore theoretical concepts to do with ethical
reasoning
• To develop knowledge and skills in the use of an ethical
decision-making model
• To apply knowledge of ethical decision making to practice
examples
Ethical Reasoning
Ethical reasoning
 Understanding values and ethics
• Values:
• Principles:
• Morality:
• Ethics:

About rights, duties, obligations, responsibilities, good and bad, right

and wrong, black and white…and all the shades of grey
Ethical Issue

Ethical Problem

Ethical Dilemma
 Ethical Dilemma
“When a worker is faced with a
choice between two equally
unwelcome alternatives that may
involve a conflict of moral principles,
and it is not clear which choice will
be the right one”
Issues that raise ethical dilemmas
in practice
• intimacy in relationships
• personal gain
• practice competence
• imposition of values or experiences
• personal mastery
• professional exploitation
 Beneficence

Non-maleficence

Honesty

Ethical Veracity

Principles Confidentiality

Justice

Respect

Autonomy
Ethical literacy:
pre-requisite for professional practice
• a clear understanding of what constitutes professional
integrity and appropriate conduct and behaviour
consistent with socially acceptable standards
• a good knowledge of issues such as privacy,
confidentiality, informed consent and capacity for consent
• clearly defined boundaries around practice that enable
professional and personal congruence
• a willingness to have their practice scrutinised by others
so that their justifications for decisions can be transparent
and accountable
Risks for those not ethically literate

• Lack of transparency in their practice

• Lack of consultation with others when necessary
• Generally, not overly concerned with ongoing
professional development
• Typically treat colleagues who raise ethical concerns with
contempt or minimise important ethical issues in a
workplace
• Neglect to follow stipulated policies or procedures, giving
preference to their own interpretations
Activity: What would you think if a
colleague did any of the following?

1. Developed a friendship with an ex-client?

2. Accepted a hand-made gift from a client?
3. Accepted a clients invitation to a party or special event?
4. Hugged or embraced a client?
5. Discussed their religious beliefs with a client? Or prayed with a client?
6. Went to work with a very bad hangover?
7. Allowed a client to follow them on Instagram?
Ethics &
CPPF
Stage 8:
Conclude
& Exit
 Ethics & CPPF Stage 8:
Conclude & Exit
• Outcomes have been evaluated to determine whether Occupational
Goals have been met
• Both parties need to come to an understanding of why the
relationship has to end (whether the OG has been achieved or not)
• The OT has to inform the client of ways for possible re-entry
(i.e. referral or work email address)
• The complexities of future occupational transitions may warrant
another contact with occupational therapy
• Determine if other referrals or community resources are required at
this time.
• Complete final report/documentation
 Ethical decisions
• For all the things that could be done for the client, what must be done?
• What action will result in the greatest benefit in this situation?
• What will be the greatest benefit for each person or group?
• What will benefit the greatest number of people?
 Erin is an occupational therapist visiting Lily to
provide ongoing assistance following the
death of her husband of 60 years. Lily has
been teary and depressed, but after several
months of visits she is starting to take an
interest in life and has started baking again.
Now, Lily insists that Erin take home one of
her baked goods each time she visits and Erin
has so far provided her family with scones,
apple pie, and a carrot cake. On Erin’s visit
Example: gifts today, Lily has remembered her mentioning
that her birthday was in the beginning of the
month and has wrapped up an antique vase
Erin had admired on one of her previous visits.
Lily is adamant that Erin accept her gift as
appreciation for all the support and assistance
she has provided over the last few months.
Should Erin accept the gift? What should she
say to Lily?
The Inclusive Model of Ethical
Decision Making

Foundational Platforms:

• Accountability
• Critical Reflection
• Cultural Sensitivity
• Consultation
• Interdependence (new!)
McAuliffe (2022)
Ethical Decision Making Model:
Steps
Step 1 Identifying the problem and defining the ethical dilemma

Step 2 Mapping legitimacy

Step 3 Gathering information

Step 4 Development of alternate approaches and action

Step 5 Critical analysis and evaluation

 Step 1: Identifying the problem and
defining the ethical dilemma

Identify competing ethical principles and which ones are in conflict.

• Best interests of client vs. interests of third party

• Duty of care vs. confidentiality

• Collegial relationships vs. loyalty to employer

• Disclosure vs. privacy

Step 1: Key questions
1. Can I clearly define competing ethical principles in this
situation? If so, what are they? If not, do I need to consult
with an appropriate other to clarify my thoughts? Are issues
of culture involved here? (consultation, cultural sensitivity)
2. If I determine that this is an ethical dilemma, where am I
placed within it? Is it my role to make a decision, or should
this situation be referred to someone with higher authority?
(accountability)
3. Is this situation familiar to me or do I need new knowledge?
Can I draw on past experience or on what I have learnt from
work in other contexts? (critical reflection)
Step 2: Mapping legitimacy

Practitioners should ask

questions about whether it is
appropriate for certain people
to be privy to information
while others are denied such
access.
Step 2: Key questions
1. Who has legitimacy in this situation? Who is included and who is
excluded? Are there any cultural factors to take into account
(e.g. extended family or kin)?

2. Is it appropriate to share this ethical dilemma with others? Is this an

ethical dilemma I am facing alone, or are others also involved?
Who should be talking to whom at this stage? (consultation;
accountability, critical reflection)

3. If it is not appropriate to share my ethical dilemma at this time, why

not and what are the implications? (critical reflection)
 Step 3: Gathering information
Information to be gathered is specific to
practice standards, codes of conduct,
protocols, legal precedent and
organizational policies.

• Documents and policies/procedures

(the material)
• Analysis of personal, professional and
societal values (the philosophical)
 Step 3: Key questions
1. What guidance is provided by professional codes of ethics, protocols, policies or
procedures, and are there any legal considerations? (accountability)
2. Are there any conflicts between personal values, professional requirements and
organisational mandates, and are these conflicts likely to present problems for the
decision-makers or others? (critical reflection)
3. Are there other resources that could shed light on this dilemma such as research,
literature or the experiences of others? (consultation; critical reflection)
4. Who could be consulted at this stage for the acquisition of new knowledge, or the
clarification of positions taken by ethical codes, policies or law? (consultation)
5. Is specific cultural knowledge required, and if so, who should be consulted for this?
(cultural sensitivity)
 Step 4: Development of alternate
approaches and action

A list of possible decisions can be

developed when the previous step is
completed.
• Robust decision-making processes
will allow for differences of
professional opinion.
• In the interests of critical reflection
and accountability, it is important
that we thoroughly explore
implications and consequences.
 Step 4: Key questions
1. What are the available courses of action now that I have gathered knowledge and
information and considered the range of value positions? (accountability)

2. On what basis will I make a decision, and how will I justify my actions?
(accountability)

3. Am I missing other alternatives, and how can I be sure that I have weighed up all the
options? Who can I talk to about this and can someone else play ‘devils advocate’
to help me clarify my position? (consultation)

4. Are any of these options culturally discriminatory or insensitive? (cultural sensitivity)

5. How do I feel about the decision I have come to, and is there anything I need to do
differently? Can I live with this decision and can I justify it if called upon? How do I
implement and document this decision? (critical reflection; accountability)
 Step 5:
Critical analysis and evaluation

• Ethical decision-making often happens quickly

• There is often little time for systematic reflection
• Supervision is sometimes used as a way of going back over events

➢ knowledge gained
➢ confidence built
➢ impact on self and practice
 Step 5: key questions
1. What have I learnt from this situation about the way I make decisions and have I
changed my behaviour from previous decision-making patterns? (critical reflection)

2. Do I feel confident that I acted in a culturally sensitive manner throughout the process
or were there aspects of culture that I neglected to explore? (cultural sensitivity)

3. Did I use consultation and support wisely, and who did I choose to talk with about the
ethical dilemma? Were there others that I could, or should, have contacted for
information? (consultation)

4. Are there issues that I need to bring attention to in relation to deficits in organisational
policies/procedures, ethical codes or other processes that impact negatively on service
users? At the end of the day, can I own my decision and confidently discuss my actions
and take responsibility for my own part in the decision-making process?
(accountability)
Activity
In your groups:

1. Read the scenario provided

2. Work through Steps 1 – 4 of model with your allocated scenario
3. You have 20 minutes to complete the task
Activity feedback
 Key points
• Self-awareness of own values and beliefs and where they have come
from
• Importance of seeking support to work through ethical dilemmas and
being wise about who you seek support from
• We all see ethical issues differently
• There are often shades of grey and no clear answers, often “it
depends…”
• Using a model/framework for ethical decision making is important
 One minute paper

• What are the three most significant things you learned about ethical
reasoning during the session - write a short paragraph
• What question remains uppermost in your mind?
• Is there anything you are not clear on?
Revisit objectives
• To explore theoretical concepts to do with ethical
reasoning
• To develop knowledge and skills in the use of an ethical
decision-making model
• To apply knowledge of ethical decision making to practice
examples
Coming up
Week 10
Tutorial: Pragmatic reasoning

Week 11
Workshop & tutorial: Putting it all together
(viva prep!)

Week 12
Workshop only (more viva prep!)
References
McAuliffe, D., & Chenoweth, L. (2008). Leave no stone unturned: The
inclusive model of ethical decision making. Ethics and Social Welfare,
2(1), 38-49. https://doi.org/10.1080/17496530801948739

McAuliffe, D. (2022). Ethical Decision making. In D McAuliffe (Ed),

Interprofessional ethics: Collaboration in the social, health and human
services (Second ed.) (pp. 97-119). Cambridge University Press.
doi:10.1017/9781108980067