ETHICS – NORTH CAROLINA OCCUPATIONAL THERAPY
GOALS AND OBJECTIVES
Course Description
“Ethics – North Carolina Occupational Therapy” is a home study continuing education program for NC licensed occupational therapists and occupational therapist assistants. The course focuses on defining moral, ethical, and legal behavior of North Carolina licensed occupational therapy professionals. The information presented includes discussions on the theoretical basis for ethical decision-making, the AOTA Code of Ethics and hypothetical case studies.
Course Rationale
This course was developed to educate, promote and facilitate ethical and legal behavior by North Carolina licensed occupational therapists and occupational therapist assistants, and is intended to meet the Ethics requirement as mandated by 21 NCAC, Chapter 38.
Course Goals & Objectives
At the end of this course, the participants will be able to:
1. Define the meaning of ethics and recognize the various theories that promote ethical behavior.
2. Apply a systematic approach to ethical decision-making.
3. Recognize the principles of ethical conduct as defined by the established and accepted Occupational Therapy Code of Ethics
4. Assess their current professional practices to ensure ethical conduct
5. Apply the concepts of ethical practice to clinical situations to determine appropriate professional ethical behavior.
Course Instructor
Michael Niss, DPT
Target Audience
Occupational therapists and occupational therapist assistants
Course Educational Level
This course is applicable for introductory learners.
Course Prerequisites
None
Criteria for issuance of Continuing Education Credits
A documented score of 70% or greater on the written post-test.
Continuing Education Credits
One (1) hour of continuing education credit (1 NBCOT PDUs/1 contact hour)
AOTA - .1 AOTA CEU, Category 3: Contemporary Issues & Trends
Determination of Continuing Education Credit Hours
“Ethics – North Carolina Occupational Therapy” will require at least 1 hour to complete. This estimate is based on the accepted standard for home study courses of approximately 12 pages of written text (12 pt font) per hour. The complete text of this course is 15 pages (excluding Bibliography and Post Test)
OUTLINE
page
Goals and Objectives 1
Outline 2
Ethics Overview 3
Why Ethics are Important 3
Ethics vs. Morals 3
Ethical Questions 3
Ethics Theories 4-5
Utilitarianism 4
Social Contract Theory 4
Deontological Theory 4
Ethical Intuitionism 4
Ethical Egoism 4
Natural Law Theory 4
Virtue Ethics 4-5
How to Make Right Decisions 5-6
Occupational Therapy Code of Ethics 7-10
Case Studies 10-14
Case Study #1 – Confidentiality 10-11
Case study #2 – Qualifications of Practice 12-13
Case Study #3 – Informed Consent 11-12
Case Study #4 – Medical Necessity 13
Case Study #5 – Conflict of Interest 13-14
Case Study #6 – Relationships / Referral Sources 14-15
References 16
Post-Test 17-18
.
ETHICS OVERVIEW
The word “ethics” is derived from the Greek word ethos (character), and from the Latin word mores (customs). Together, they combine to define how individuals choose to interact with one another. In philosophy, ethics defines what is good for the individual and for society and establishes the nature of duties that people owe themselves and one another. Ethics is also a field of human inquiry (“science” according to some definitions) that examines the bases of human goals and the foundations of “right” and “wrong” human actions that further or hinder these goals.
Ethics are important on several levels.
Ethics vs. Morals
Although the terms “ethics” and “morals” are often used interchangeably, they are not identical. Morals usually refer to practices; ethics refers to the rationale that may or may not support such practices. Morals refer to actions, ethics to the reasoning behind such actions. Ethics is an examined and carefully considered structure that includes both practice and theory. Morals include ethically examined practices, but may also include practices that have not been ethically analyzed, such as social customs, emotional responses to breaches of socially accepted practices and social prejudices. Ethics is usually at a higher intellectual level, more universal, and more dispassionate than morals. Some philosophers, however, use the term “morals” to describe a publicly agreed-upon set of rules for responding to ethical problems.
Ethical Questions
Ethical questions involve 1) responsibilities to the welfare of others or to the human community; or 2) conflicts among loyalties to different persons or groups, among responsibilities associated with one’s role (e.g. as consumer or provider), or among principles. Ethical questions include (or imply) the words “ought” or “should”.
Throughout history, mankind has attempted to determine the philosophical basis from which to define right and wrong. Here are some of the more commonly accepted theories that have been proposed.
Utilitarianism
This philosophical theory develops from the work of Jeremy Bentham and John Stewart Mill. Simply put, utilitarianism is the theory that right and wrong is determined by the consequences. The basic tool of measurement is pleasure (Bentham) or happiness (Mill). A morally correct rule was the one that provided the greatest good to the greatest number of people.
Social Contract Theory
Social contract theory is attributed to Thomas Hobbes, John Locke, and from the twentieth century, John Rawls. Social contract theories believe that the moral code is created by the people who form societies. These people come together to create society for the purpose of protection and gaining other benefits of social cooperation. These persons agree to regulate and restrict their conduct to achieve this end.
Under this theory you determine if an act or rule is morally right or wrong if it meets a moral standard. The morally important thing is not consequences but the way choosers think while they make choices. One famous philosopher who developed such a theory was Immanuel Kant (1724-1804).
Under this view an act or rule is determined to be right or wrong by appeal to the common intuition of a person. This intuition is sometimes referred to as your conscience. Anyone with a normal conscience will know that it is wrong to kill an innocent person.
This view is based on the theory that each person should do whatever promotes their own best interests; this becomes the basis for moral choices.
Natural Law Theory
This is a moral theory which claims that just as there are physical laws of nature, there are moral laws of nature that are discoverable. This theory is largely associated with Aristotle and Thomas Aquinas, who advocated that each thing has its own inherent nature, i.e. characteristic ways of behavior that belong to all members of its species and are appropriate to it. This nature determines what is good or bad for that thing. In the case of human beings, the moral laws of nature stem from our unique capacity for reason. When we act against our own reason, we are violating our nature, and therefore acting immorally.
This ethics theory proposes that ethical behavior is a result of developed or inherent character traits or virtues. A person will do what is morally right because they are a virtuous person. Aristotle (384-322 B.C.) was a famous exponent of this view. Aristotle felt that virtue ethics was the way to attain true happiness. These are some of the commonly accepted virtues.
Autonomy: the duty to maximize the individual’s right to make his or her own decisions.
Beneficence: the duty to do good.
Confidentiality: the duty to respect privacy of information.
Finality: the duty to take action that may override the demands of law, religion, and social customs.
Justice: the duty to treat all fairly, distributing the risks and benefits equally.
Nonmaleficence: the duty to cause no harm.
Understanding/Tolerance: the duty to understand and to accept other viewpoints if reason dictates.
Respect for persons: the duty to honor others, their rights, and their responsibilities.
Universality: the duty to take actions that hold for everyone, regardless of time, place, or people involved.
Veracity: the duty to tell the truth.
The foundation for making proper ethical decisions is rooted in an individual’s ability to answer several fundamental questions concerning their actions.
Weighing the legality of one’s actions is a prudent way to begin the decision-making process. The laws of a geographic region are a written code of that region’s accepted rules of conduct. This code of conduct usually defines clearly which actions are considered acceptable and which actions are unacceptable. However, a legitimate argument can be made that sometimes what is legal is not always moral, and that sometimes what is moral is not always legal. This idea is easily demonstrated by the following situation.
It is illegal for a pedestrian to cross a busy street anywhere other than at the designated crosswalk (jaywalking). A man is walking down a street and sees someone fall and injure themselves on the other side of the street. He immediately crosses the street outside of the crosswalk to attend to the injured person. Are his actions legal? Are they moral? What if by stepping into the street he causes a car to swerve and to strike another vehicle?
Admittedly, with the exception of policemen and attorneys, most people do not know all of the specific laws that govern their lives. However, it is assumed that most people are familiar with the fundamental virtues from which these laws are based, and that they will live their lives in accordance with these virtues.
(To read the NC laws and rules governing Occupational Therapy, please go to: http://www.ncbot.org/ )
Professional ethical behavior as it is defined in this context relates to actions that are consistent with the normative standards established or practiced by others in the same profession. For occupational therapists and occupational therapist assistants, these ethical standards are documented in the American Occupational Therapy Association’s Occupational Therapy Code of Ethics (2005). All OTs and OTAs, even those who are not members of the AOTA, are bound to these guidelines. This is because The AOTA Code of Ethics is the accepted and de facto standard of practice throughout the profession.
(To read the AOTA Occupational Therapy Code of Ethics, go to: www.aota.org/general/docs/ethicscode05.pdf)
I think most people would agree that the concept of fairness is often highly subjective. However, for these purposes, we will define fairness as meaning deserved, equitable and unbiased. Fairness requires the decision-maker to have a complete understanding of benefits and liabilities to all parties affected by the decision. Decisions that result in capricious harm or arbitrary benefit cannot be considered fair. The goal of every decision should be an outcome of relative equity that reflects insightful thought and soundness of intent.
This question presents as a true reflection of the other three. Legal, ethical, and fair are defined quite differently by most people when judged in the comfort of anonymity versus when it is examined before the forum of public opinion. Most often it is the incorrect assumption that “no one will ever find out about this” that leads people to commit acts of impropriety. How would your decisions change, if prior to taking any actions, you assumed just the opposite; “other people will definitely know what I have done”. One sure sign of a poor decision is debating the possible exposure of an action instead of examining the appropriateness of it.
OCCUPATIONAL THERAPY CODE OF ETHICS
Principle 1. Occupational therapy personnel shall demonstrate a concern for the well-being of the recipients of their services. (beneficence)
A. Occupational therapy personnel shall provide services in a fair and equitable manner. They shall recognize and appreciate the cultural components of economics, geography, race, ethnicity, religious and political factors, marital status, sexual orientation, and disability of all recipients of their services.
B. Occupational therapy practitioners shall strive to ensure that fees are fair and reasonable and commensurate with services performed. When occupational therapy practitioners set fees, they shall set fees considering institutional, local, state, and federal requirements, and with due regard for the service recipient's ability to pay.
C. Occupational therapy personnel shall make every effort to advocate for recipients to obtain needed services through available means.
Principle 2. Occupational therapy personnel shall take reasonable precautions to avoid imposing or inflicting harm upon the recipient of services or to his or her property. (nonmaleficence)
A. Occupational therapy personnel shall maintain relationships that do not exploit the recipient of services sexually, physically, emotionally, financially, socially, or in any other manner.
B. Occupational therapy practitioners shall avoid relationships or activities that interfere with professional judgment and objectivity.
Principle 3. Occupational therapy personnel shall respect the recipient and/or their surrogate(s) as well as the recipient's rights. (autonomy, privacy, confidentiality)
A. Occupational therapy practitioners shall collaborate with service recipients or their surrogate(s) in setting goals and priorities throughout the intervention process.
B. Occupational therapy practitioners shall fully inform the service recipients of the nature, risks, and potential outcomes of any interventions.
C. Occupational therapy practitioners shall obtain informed consent from participants involved in research activities and indicate that they have fully informed and advised the participants of potential risks and outcomes. Occupational therapy practitioners shall endeavor to ensure that the participant(s) comprehend these risks and outcomes.
D. Occupational therapy personnel shall respect the individual's right to refuse professional services or involvement in research or educational activities.
E. Occupational therapy personnel shall protect all privileged confidential forms of written, verbal, and electronic communication gained from educational, practice, research, and investigational activities unless otherwise mandated by local, state, or federal regulations.
Principle 4. Occupational therapy personnel shall achieve and continually maintain high standards of competence. (duties)
A. Occupational therapy practitioners shall hold the appropriate national and state credentials for the services they provide.
B. Occupational therapy practitioners shall use procedures that conform to the standards of practice and other appropriate AOTA documents relevant to practice.
C. Occupational therapy practitioners shall take responsibility for maintaining and documenting competence by participating in professional development and educational activities.
D. Occupational therapy practitioners shall critically examine and keep current with emerging knowledge relevant to their practice so they may perform their duties on the basis of accurate information.
E. Occupational therapy practitioners shall protect service recipients by ensuring that duties assumed by or assigned to other occupational therapy personnel match credentials, qualifications, experience, and scope of practice.
F. Occupational therapy practitioners shall provide appropriate supervision to individuals for whom the practitioners have supervisory responsibility in accordance with Association policies, local, state and federal laws, and institutional values.
G. Occupational therapy practitioners shall refer to or consult with other service providers whenever such a referral or consultation would be helpful to the care of the recipient of service. The referral or consultation process should be done in collaboration with the recipient of service.
Principle 5. Occupational therapy personnel shall comply with laws and Association policies guiding the profession of occupational therapy. (justice)
A. Occupational therapy personnel shall familiarize themselves with and seek to understand and abide by applicable Association policies; local, state, and federal laws; and institutional rules.
B. Occupational therapy practitioners shall remain abreast of revisions in those laws and Association policies that apply to the profession of occupational therapy and shall inform employers, employees, and colleagues of those changes.
C. Occupational therapy practitioners shall require those they supervise in occupational therapy-related activities to adhere to the Code of Ethics.
D. Occupational therapy practitioners shall take reasonable steps to ensure employers are aware of occupational therapy's ethical obligations, as set forth in this Code of Ethics, and of the implications of those obligations for occupational therapy practice, education, and research.
E. Occupational therapy practitioners shall record and report in an accurate and timely manner all information related to professional activities.
Principle 6. Occupational therapy personnel shall provide accurate information about occupational therapy services. (veracity)
A. Occupational therapy personnel shall accurately represent their credentials, qualifications, education, experience, training, and competence. This is of particular importance for those to whom occupational therapy personnel provide their services or with whom occupational therapy practitioners have a professional relationship.
B. Occupational therapy personnel shall disclose any professional, personal, financial, business, or volunteer affiliations that may pose a conflict of interest to those with whom they may establish a professional, contractual, or other working relationship.
C. Occupational therapy personnel shall refrain from using or participating in the use of any form of communication that contains false, fraudulent, deceptive, or unfair statements or claims.
D. Occupational therapy practitioners shall accept the responsibility for their professional actions which reduce the public's trust in occupational therapy services and those that perform those services.
Principle 7. Occupational therapy personnel shall treat colleagues and other professionals with fairness, discretion, and integrity. (fidelity)
A. Occupational therapy personnel shall preserve, respect, and safeguard confidential information about colleagues and staff, unless otherwise mandated by national, state, or local laws.
B. Occupational therapy practitioners shall accurately represent the qualifications, views, contributions, and findings of colleagues.
C. Occupational therapy personnel shall take adequate measures to discourage, prevent, expose, and correct any breaches of the Code of Ethics and report any breaches of the Code of Ethics to the appropriate authority.
D. Occupational therapy personnel shall familiarize themselves with established policies and procedures for handling concerns about this Code of Ethics, including familiarity with national, state, local, district, and territorial procedures for handling ethics complaints. These include policies and procedures created by the American Occupational Therapy Association, licensing and regulatory bodies, employers, agencies, certification boards, and other organizations who have jurisdiction over occupational therapy practice.
John Johnson OT, Sue White (therapy receptionist), and Mary Olson (director of managed care contracting), are in a private OT office discussing the fact that they are treating Biff Simpson, a star NFL quarterback. John says, “I can’t believe that I’m actually treating Biff Simpson.” Mary asks, “How bad do you think his injury is?” John replies, “I saw his MRI report, it looks like he is going to need surgery.”
Is this a breach in confidentiality?
The information contained in each patient’s medical record must be safeguarded against disclosure or exposure to nonproprietary individuals. The right to know any medical information about another is always predicated on a sound demonstration of need. Frequently, many individuals require access to information contained in a patient’s medical record. Their right to access this information is limited to only that information which is deemed necessary for them perform their job in a safe, effective, and responsible manner.
The first questions we must ask are “What information is being disclosed and do the three individuals engaged in the conversation have a need to know this information?”
John’s first statement discloses the name of person receiving care, and his second statement reveals private patient medical information. Certainly, as the primary therapist, John would need to know the patient’s name and therapy related diagnosis in order to provide care. Sue, the receptionist, may also need this information to schedule appointments and perform other essential clerical tasks. Mary, whose job it is to contract with managed care organizations, most likely has no compelling reason to know either the patient’s identity or any of his medical information. Therefore, the disclosure to Mary of the patient’s identity and medical information is a breach of patient confidentiality. (Principle 3E)
Case Study #2 – Qualifications of Practice
You work in very busy outpatient rehab clinic. One of your coworkers is an occupational therapy aide who has worked in rehabilitation for more than 20 years. Frequently, she is called upon to perform treatments that should be done by an OT or COTA. The patients always give her compliments, and frequently request her to treat them. She demonstrates exceptional skills and achieves outstanding outcomes.
Is the clinic providing ethical care to its patients?
The practice of occupational therapy is regulated in the state of North Carolina. The legislature, through statutes and rules, has established minimal licensure and practice standards. This is done to protect the general public against fraud and substandard care by under-qualified practitioners. It is the responsibility of each occupational therapy professional to adhere to the standards of care and licensure requirements specific to the state in which they practice. The therapist must also ensure that all care provided not directly by them, but under their supervision, also meets these standards.
In this situation, the aide’s abilities and outcomes are considered irrelevant. The key sentence in the paragraph is: “perform treatments that should be done by an OT or COTA”. The “should” in this case must not be interpreted as merely a casual suggestion but rather a legal definition regulated by the state’s Occupational Therapy Practice Act. Any treatment or procedure that should be performed by a licensed professional, must be performed by a licensed professional. (Principles 4A, 4E)
Case Study #3 – Informed Consent
Sam is an OT who has just received orders to begin ADL training with a 75-year-old woman who is s/p right humeral ORIF. He goes to her hospital room to evaluate her and begin therapy. She says she does not want therapy today because she is in too much pain. Sam explains to her that the doctor has left orders for her to begin using her right arm. The patient refuses. Sam leaves and returns the next day to try again. Again, she declines treatment and he leaves.
Under the guidelines of informed consent, were the therapist’s actions adequate?
Informed consent is the process by which a fully informed patient can participate in choices about their health care. It originates from the legal and ethical right the patient has to direct what happens to their body and from the ethical duty of the therapist to involve the patient in her health care.
The most important goal of informed consent is that the patient has an opportunity to be an informed participant in their health care decisions. It is generally accepted that complete informed consent includes a discussion of the following elements:
· the nature of the decision/procedure
· reasonable alternatives to the proposed intervention
· the relevant risks, benefits, and uncertainties related to each alternative
· the consequences on non-treatment
· the goals of treatment
· the prognosis for achieving the goals
· assessment of patient understanding
· the acceptance of the intervention by the patient
In order for the patient’s consent to be valid, they must be considered competent to make the decision at hand and their consent must be voluntary. It is easy for coercive situations to arise in medicine. Patients often feel powerless and vulnerable. The therapist should make clear to the patient that they are participating in a decision, not merely signing a form. With this understanding, the informed consent process should be seen as an invitation for them to participate in their health care decisions. The therapist is also generally obligated to provide a recommendation and share their reasoning process with the patient. Comprehension on the part of the patient is equally as important as the information provided. Consequently, the discussion should be carried on in layperson’s terms and the patient’s understanding should be assessed along the way.
In this case study, the therapist’s actions were not sufficient. None of the required information was offered to the patient. The most important thing the therapist failed to explain to the patient was the consequences of non-treatment. The patient cannot make an informed decision regarding therapy without this information. It could be argued that her decision to refuse therapy may have changed had she known that one of the consequences of this decision could be the development of secondary complications. (i.e. increased risk of morbidity or mortality). (Principles 3B, 3D)
Case Study #4- Medical Necessity
Mary Brown is an occupational therapist who owns her own therapy clinic. She recently signed a contract with an HMO to provide occupational therapy services. The contract stipulates that Mary will be compensated on a case rate basis. (A fixed amount of money per patient, based on diagnosis) Mary has performed a thorough cost analysis on this contract and has determined that the financial “breakeven” point (revenue equals expenses) on each of these patients is 5 visits. She informs her staff that all patients covered by this insurance must be discharged by their fourth visit.
Is limiting care in this manner ethical?
Therapists are obligated to propose and provide care that is based on sound medical rationale, patient medical necessity, and treatment efficacy and efficiency. It is unethical to either alter or withhold care based on other extraneous factors without the patient’s knowledge and consent.
In this instance, the decision to limit care is not ethical. The quantity of care is not being determined by the medical necessity of the patient. A therapist must be able to justify all of their professional decisions (such as the discharging of a patient from clinical care) based on sound clinical rationale and practices. (Principles 1A, 1C)
Case Study #5 – Conflicts of Interest
Debi Smith OT works in an acute care hospital. She is meeting with a vendor whose company is introducing a new brace onto the market. He offers her 3 free braces to “try out” on patients. The vendor states that if Debi continues to order more braces, she will qualify to receive compensation from his company by automatically becoming a member of its National Clinical Assessment Panel.
Does this represent a conflict of interest?
Yes, there exists a conflict of interest in this situation. Debi has two primary obligations to fulfill. The first is to her patient. It is her professional duty to recommend to her patient a brace that, in her judgment, will benefit them the most. The second obligation is to her employer, the hospital. As an employee of the hospital it is her responsibility to manage expenses by thoroughly and objectively seeking effective products that also demonstrate economic efficiency. The conflict of interest occurs when she begins to accept compensation from the vendor in direct or indirect response for her brace orders. Even if she truly believes it is the best brace for her patient, and it is the most cost effective brace the hospital could purchase, by accepting the money she has established at least an apparent conflict of interest. Under this situation she is obligated to disclose to all parties her financial interest in ordering the braces. This disclosure is necessitated because the potential for personal gain would make others rightfully question whether her objectivity was being influenced.
A conflict of interest is a situation in which a person has a private or personal interest that influences the objective exercise of his or her professional duties. As a professional you take on certain responsibilities and obligations to patients, employers, and others. These obligations must take precedence over a therapist’s private or personal interests.
In addition to avoiding all real instances of conflict of interest, therapists must also avoid any apparent or potential conflicts as well.
An apparent conflict of interest is one in which a reasonable person would think that the professional’s judgment is likely to be compromised, and a potential conflict of interest involves a situation that may develop into an actual conflict of interest.
How do you determine if you are in a conflict of interest, whether actual, apparent, or potential? The key is to determine whether the situation you are in interferes or is likely to interfere with your independent judgment. A good test is the ‘trust test’: Would relevant others (my employer, my patients, professional colleagues, or the general public) trust my judgment if they knew I was in this situation. Trust is at the ethical heart or core of this issue. Conflicts of interest involve the abuse, actual or potential, of the trust people have placed in professionals. This is why conflicts of interest not only injure particular patients and employers, but they also damage the whole profession by reducing the trust people generally have in therapists. (Principles 2B, 6B)
Case Study #6 – Relationships with Referral Sources
Larry Jones OT owns a private practice. Business has been poor. He decides to sublease half of his space to an orthopedic surgeon. Larry’s current lease is at $20/sq ft. The doctor wants to pay $15/sq ft. They come to a compromise of $17/sq ft. Larry also agrees that if the doctor is his top referral source after 3 months, he’ll make him the Medical Director of the facility and pay him a salary of $500/month.
Is this an ethical arrangement?
No, this agreement is not ethical. The most notable infraction involves offering to designate the physician as Medical Director contingent upon the number of referrals he sends. This is undeniably a direct offer of cash for patients. Another area of concern is the rent. At first glance, the rent amount of $17/sq ft seems fair because it was a compromise between the two parties. However, closer scrutiny reveals this to be unethical. The fair market value for rent has been established as $20/ft. (Larry’s current rental agreement with his landlord) By discounting the doctor $3/sq ft on his rent, Larry is giving a referral source something of value.
It is unethical for an occupational therapist to offer anything of value to physicians or any other referral source in direct response for the referral of patients or services. This includes cash, rebates, gifts, discounts, reduced rent, services, equipment, employees, or marketing. Many mistakenly believe that it is a normal acceptable business practice to offer these things to referral sources. It is not. In most states, the practice is not only unethical, but it is also illegal. Exchanges of valued items or services between therapists and referral sources must never have any relationship to the referral of patients. Goodwill gifts of nominal value are acceptable provided that no correlation can be made between the magnitude or frequency of the gift giving and referral patterns. All business agreements and transactions should always be well documented and most importantly, reflect fair market value. (Principles 2A, 2B. 5A, 6B)
REFERENCES
American Occupational Therapy Association (AOTA). (2004) Enforcement procedures for occupational therapy code of ethics (2004). American Journal of Occupational Therapy. 58(6):655-62, Nov-Dec.
Bailey DM. Schwartzberg SL. (2003) Ethical and legal dilemmas in occupational therapy. F.A. Davis Company (Philadelphia , Pennsylvania) 2003; 2 ed 224 p.
Barman, C. R. (1980). Four values education approaches for science teaching. American Biology Teacher, 42(3), 152-156.
Boylan, M. (2000). Basic Ethics. Englewood Cliffs, NJ: Prentice-Hall
Brandt, Richard B. (1959) Ethical Theory. Englewood Cliffs, NJ: Prentice Hall
Edwards I. Braunack-Mayer A. Jones M. (2005) Ethical reasoning as a clinical-reasoning strategy in physiotherapy. Physiotherapy. 2005 Dec; 91(4): 229-36. (45 ref)
Falikowski, A. (1998). Moral Philosophy for Modern Life. Englewood Cliffs, NJ: Prentice-Hall
Feldman, R. (1978) Introductory Ethics. Englewood Cliffs, NJ: Prentice-Hall
Garcia JG. Winston SM. Borzuchowska B. McGuire-Kuletz M. (2004) Evaluating the integrative model of ethical decision-making. Rehabilitation Education. 2004; 18(3): 147-64.
Geddes EL. Finch E. Graham K. (2005) Ethical choices: a moral and legal template for health care practice...including commentary by Weinacht K. Physiotherapy Canada. 2005 Spring; 57(2): 113-22. (30 ref)
Glover Takahashi S. (2004) Stepping out of the shadows: The learning of ethical conduct through the "I" and "eye" of physiotherapists. (University of Toronto (Canada)) 2004; Ph.D. 351 p.
Greenfield BH. (2006) The meaning of caring in five experienced physical therapists. Physiotherapy Theory & Practice. 22(4):175-87, 2006 Sep.
Horowitz BP. (2002) Ethical decision-making challenges in clinical practice. Occupational Therapy in Health Care. 2002; 16(4): 1-14.
http://codes.ohio.gov/oac/4755-7-08
http://maine.gov/sos/cec/rules/02/477/477c007.doc
Kashman S. Savage TA. (2003) Ethics in practice. Rehabilitation health care executives and ethical issues. Topics in Stroke Rehabilitation. 2003 Summer; 10(2): 130-3.
Kirsch NR. (2007) Ethics in action. Improper conduct: case two. PT--Magazine of Physical Therapy. 2007 Jun; 15(6): 34-7
Kirsch NR. (2007) Ethics in action. Issues of professional integrity: analysis. PT--Magazine of Physical Therapy. 2006 Jul; 14(7): 38-42.
Kuczewski MG. Fiedler I. (2005) Ethical issues in physical medicine and rehabilitation: treatment decision making with adult patients. Critical Reviews in Physical and Rehabilitation Medicine. 2005; 17(1): 31-52.
McCormick-Gendzel M. Jurchak M. (2006) A pathway for moral reasoning in home healthcare. Home Healthcare Nurse. 2006 Nov-Dec; 24(10): 654-61, 670-1. (14 ref 9 bib)
Metzger ED. Gillick MR. (2003) Ethics corner: cases from the Hebrew Rehabilitation Center for Aged -- friends. Journal of the American Medical Directors Association. 2003 Mar-Apr; 4(2): 109-11. (14 ref)
Nalette E. (2001) Physical therapy: ethics and the geriatric patient. Journal of Geriatric Physical Therapy. 2001; 24(3): 3-7.
Slater DY. (2006) The ethics of productivity: occupational therapy practitioners have a legal and ethical responsibility to their clients, regardless of facility policies. OT Practice. 2006 Oct 23; 11(19): 17-20.
Swisher LL. (2002) A retrospective analysis of ethics knowledge in physical therapy (1970-2000). [Review] [123 refs] Physical Therapy. 82(7):692-706, 2002 Jul.
White, T. (1988) Right and Wrong: A Brief Guide to Understanding Ethics. Englewood Cliffs, NJ: Prentice-Hall
www.ecptote.state.tx.us/pdf/ot_374-4_1201.pdf
www.lrc.ky.gov/kar/201/028/140.htm
www.llr.state.sc.us/pol/OccupationalTherapy/PDFForms/AOTAEthicsCode.pdf
www.oregon.gov/OTLB/docs/AOTACodeofEthics.pdf.pdf
ETHICS – NORTH CAROLINA OCCUPATIONAL THERAPY
POST-TEST
A. Utilitarianism
B. Social Contract Theory
C. Ethical Egoism
D. Natural Law Theory
A. John Stewart Mills
B. Thomas Hobbs
C. Immanuel Kant
D. Aristotle
A. Deontological Theory
B. Ethical Intuitionism
C. Ethical Egoism
D. Virtue Ethics
A. Beneficence
B. Finality
C. Nonmaleficence
D. Veracity
A. Actions that are legal are always morally right.
B. Actions that are morally right are always legal.
C. Both A and B are TRUE
D. Neither A nor B is TRUE
A. Principle 3
B. Principle 4
C. Principle 5
D. Principle 7
A. Principle 1
B. Principle 2
C. Principle 4
D. Principle 6
A. reasonable alternatives
B. consequences of non-treatment
C. prognosis for achieving goals
D. all of the above
A. medical necessity
B. conflict of interest
C. informed consent
D. confidentiality
A. Having a referring physician as your facility’s Medical Director
B. Sending holiday cookies to all local case managers
C. Giving concert tickets to the doctor who refers the most patients each month
D. Subleasing office space to a physician