Ethical Aspects in the work with elders ch. 10

What is the next step the COTA should take in the ethical decision-making process after the COTA has identified an appropriate support person? A. Implement the action. B. Identify the problem. C. Decide what action to take. D. Decide with whom to speak about the dilemma.

ANS: A The step following the identification of a support person is to implement the action to resolve the ethical dilemma.

Who is responsible for the legal and ethical conduct of the COTA? A. The COTA's supervisor B. The administrator of the facility C. The COTA D. The State Regulatory Board

ANS: C COTAs are responsible and accountable for knowing the state regulations guiding their practice, maintaining clinical competence, and providing legal and ethical care.

As a part of the health care team, what role(s) can the COTA play in solving ethical dilemmas? A. Be a support person to the employee having the dilemma. B. Provide advice on the AOTA's ethical principles. C. Assist peers in considering the benefits and burdens of possible solutions to ethical dilemmas. D. All of the above

ANS: D The COTA can play several roles in solving ethical dilemmas for the health care team. All of the roles listed can be performed by the COTA.

Who may be involved in the ethical decision making regarding a patient's OT care? A. The COTA B. The patient C. The family D. All of the above

ANS: D The COTA, patient, OTR, physician, and other health care staff are involved with the family in making ethical decisions for the patient. Knowing which individuals need to be involved in decision making is critical to the COTA. Knowing when to alert supervisors and other health care personnel is also important to the COTA's role.

What is client autonomy? A. The ability of adults to make informed decisions about whether to accept or refuse treatment B. The ability of adults to decide on which treatments they believe are going to be most effective for their situation C. The responsibility of the health care provider to inform the client on the treatment plan D. Informing the client about the risks and benefits of a treatment before proceeding to do that treatment

ANS: A In the health care setting, autonomy refers to the idea that adults have the right to be involved in determining their plans of care and relevant intervention decisions. To ensure that clients have the information they need to make decisions consistent with good clinical outcomes, practitioners must communicate effectively regarding the benefits and burdens of potential interventions.

What is the correct definition of the term "distributive justice"? A. A situation that arises when there is not enough of something (e.g., goods or services) that is valued B. A situation that arises when the COTA knows which course of action to take but is unable to do so without some personal risk C. A situation in which there are two or more ethically correct options for action, but with each choice, the COTA compromises something of value D. A situation in which there is a legal discrepancy between what is right and what should be done for the client

ANS: A The definition of distributive justice is a situation that arises when there is not enough of something (e.g., goods or services) that is valued. The COTA must distribute the item or service in a fair way, or in the language of ethics, a "just" way.

Mr. Tom is a COTA with 2 years of experience when he takes a new position in a long-term care facility. Mr. Tom observes the OTR changing patient records to increase the reimbursement for the OT delivered by the department. What is the first action Mr. Tom should take? A. Gain a clear understanding of what exactly the OTR did and whether it was an unethical or illegal action. B. Report the OTR to the administrator immediately. C. Report the OTR to the State Regulatory Board. D. Report the OTR to the AOTA along with all of the patient record documentation.

ANS: A The first step the COTA should take is to identify what kind of ethical problem is occurring. By investigating the actions of the OTR in this instance, the COTA can figure out what kind of ethical problem he or she is facing. This should be done before contacting anybody inside and outside the facility.

What is the next step the COTA takes in the ethical decision making process after identifying who is involved, knowing the laws and institutional rules, and seeking guidance from the AOTA's Code of Ethics? A. Becoming aware of the range of options available before making a decision B. Self-reflecting on what you personally think should happen C. Deciding what action to take D. Evaluating the decision's outcome

ANS: A The next step after reviewing the Code of Ethics is to become aware of all of the possible options (solutions) to the ethical problem.

What is one of the ethical challenges for a COTA in today's health care environment? A. Deciding which treatments to provide to a person requiring OT B. Providing cost-effective treatment to the right patient at the right time C. Trying to decide whether or not a patient should receive OT services D. Documenting the care provided so reimbursement will not be affected

ANS: B COTAs should be able to decide which treatments are effective for a patient as well as whether or not treatment is needed. COTAs are able to chart correctly so reimbursement will not be affected. The challenge for OTRs and COTAs is to provide the right cost-effective treatment to the right patient at the right time to ensure that high-quality care is provided that is cost effective.

Katie is a COTA who has been treating an elderly client for several weeks and has developed an empathetic relationship with the client. Katie is having difficulty balancing her empathetic relationship with her professional responsibility to avoid over involvement. What advice would you give Katie? A. Continue the empathetic relationship because it is comforting to the patient and is part of the professional relationship. B. Find a balance in the relationship with the client and try using tools for ethical reflection such as walks, meditation, or reading. C. Ask to have her assignment changed so she can continue befriending the client without worrying about overstepping her professional role. D. When the relationship is out of balance, a solution is not possible, so the COTA should resign her position.

ANS: B Finding a balance between genuine caring for clients and realistic boundaries for professional involvement is a lifelong goal for all health care professionals that requires ongoing ethical introspection. Useful tools for ethical reflection include prayer, meditation, nature walks, and reading. COTAs must step away from the urgency of the problem to gain perspective about their responsibilities. The COTA should not change assignments or resign but should move forward by working through the situation.

If a COTA demonstrates unlawful behavior, incompetence or unethical behavior, what actions can the State Regulatory Board take? A. Removal of licensure and termination from their current position B. Public reprimand and removal from practice C. Termination from the current position D. Denial of licensure in any other country

ANS: B State Regulatory Boards, created by state legislatures, have the power to intervene if they determine the public to be at risk because of a practitioner's incompetence, lack of qualifications, or unlawful behavior. State boards can publicly reprimand a practitioner or, if warranted, may even prohibit someone from practicing in that state.

Which action can the NBCOT take on a COTA who has demonstrated an unethical or illegal behavior in practice? A. Conduct an open and public investigation of the incident B. Permanently deny or revoke the COTA's certification C. Nothing at all; they have no control over a COTA's certification D. None of the above

ANS: B The NBCOT is responsible for certifying OTRs and COTAs. Depending on the significance of the unethical behavior that is reported and after a thorough and confidential investigation, the NBCOT may take action by denying or revoking certification.

What is the correct definition of "ethical distress"? A. A situation that arises when there is not enough of something (e.g., goods or services) that is valued B. A situation that arises when the COTA knows which course of action to take but is unable to do so without some personal risk C. A situation in which there are two or more ethically correct options for action, but with each choice, the COTA compromises something of value D. A situation in which there is a legal discrepancy between what is right and what should be done for the client

ANS: B The definition of ethical distress is a situation in which there are two or more ethically correct options for action, but with each choice, the COTA compromises something of value.

What does the COTA take into account when considering possible options in solving an ethical dilemma? A. The patient's desires for treatment B. The physician's orders written for treatment C. The benefits and burdens of all possible solutions D. The COTA's desires for treatment

ANS: C The consequences of ethical decisions can be weighed against the consequences of other options. The ethically preferable course of action is that which carries the greatest chance of a good outcome (benefits) and the least amount of damage (burdens).

What is the correct definition of the term "ethical dilemma"? A. A situation that arises when there is not enough of something (e.g., goods or services) of something that is valued B. A situation that arises when the COTA knows which course of action to take but is unable to do so without some personal risk C. A situation in which there are two or more ethically correct options for action, but with each choice, the COTA compromises something of value D. A situation in which there is a legal discrepancy between what is right and what should be done for the client

ANS: C The definition of ethical dilemma is a situation in which there are two or more ethically correct options for action. However, with each choice, the COTA compromises something of value.

Which health care positions would normally be represented on a hospital ethics committee? A. COTAs B. Nurses C. Administrators and legal counsel D. All of the above

ANS: C Typically, institutional ethics committees (hospital ethics committees) are composed of staff, administrators, legal counsel, and a community representative. COTAs are not typically found on this committee.

If a COTA or OTR demonstrates unethical behaviors, his or her actions can be reported to which organization(s)? A. American Occupational Therapy Organization B. National Board for Certification in Occupational Therapy C. State Regulatory Board D. All of the above

ANS: D Depending on the ethical or legal violation any or all of the listed organizations may be notified to conduct an investigation of the COTA or OTR. Reporting another's unethical behavior is sometimes referred to as "whistle-blowing" and is a difficult position for the COTA to be in.

What is the next step the COTA should take in the ethical decision-making process after reflecting on what you the COTA thinks should happen? A. Become aware of the range of options available before making a decision. B. Identify the problem. C. Decide what action to take. D. Decide to whom to speak about the dilemma.

ANS: D Often the reflection stage of ethical consideration requires some emotional and even physical detachment as COTAs step back from the problem to reflect on their ethical commitments and reasoning. Before acting according to moral convictions, COTAs should solicit the support of others who will be affected by the issue. In almost all instances of ethics in health care, this means communicating with the client, the client's family, and other staff members. Sometimes the organization's ethics committee can provide institutional support for a COTA's position.

Which of the following can be considered an action in resolving an ethical dilemma? A. Taking no action at all and "staying out of it" B. Speaking with a supervisor to identify possible actions to resolve the conflict C. Speaking with the family members to determine their desires D. All of the above

ANS: D Taking no action at all when an ethical dilemma or unethical behavior has occurred is one action the COTA can take. It does not eliminate the responsibility of the COTA to do the "right" thing in seeking assistance in resolving the dilemma.

Which of the following is NOT part of the AOTA Code of Ethics? A. Occupational therapy personnel shall demonstrate a concern for the safety and well-being of the recipients of their services. B. Occupational therapy personnel shall respect recipients to assure their rights. C. Occupational therapy personnel shall comply with laws and Association policies guiding the profession of occupational therapy. D. Occupational therapy personnel shall consider the personal activities and occupations of all recipients of their services.

ANS: D The AOTA's Code of Ethics does not include "Occupational therapy personnel shall consider personal activities and occupations of all recipients of their services."