Ethics

What has the AOTA Ethics Commission recommended that occupational therapy authors do to avoid plagiarism in the electronic age?

Because it is challenging to ensure that authors have appropriately cited all sources, use of electronic tools is recommended to ensure that papers and presentations are not plagiarized.

Which client factor is likely affected in a client in the hospital-based setting with Guillain-Barré syndrome?

Because of the painful sensations that are intially reported with Guillain-Barré syndrome, the client's tolerance for tactile input and current sensory abilities will likely influence interventions with the client.

A COTA® is working with a client with Stage III amyotrophic lateral sclerosis. Which strategy is BEST to help this client maintain the current level of participation in daily activities?

Having the caregiver assist the client with ADLs is the best strategy at ALS Stage III, which is characterized by an increased level of fatigue.

A COTA® is engaged in a casual discussion with a colleague about a client. The COTA conveys that the client is rude and obnoxious but deserves to be treated equally. What is the ethical basis for the COTA's concern?

In the Occupational Therapy Code of Ethics (2015), Principle 4, Justice, states, "Occupational therapy personnel shall promote fairness and objectivity in the provision of occupational therapy services."

A COTA® is working with a client with Guillain-Barré syndrome who is in the recovery phase. Which intervention BEST addresses the needs of the client in this phase?

In the recovery phase of Guillain-Barré syndrome, taking rest periods without pushing to the point of fatigue is recommended while gradually increasing tolerance for activity.

Which of the following symptoms would a COTA® expect to see with a client with Guillain-Barré syndrome in the acute inflammatory phase?

Because ascending paralysis is typical of Guillain-Barré syndrome, observations during sessions consistently focus on the constellation of symptoms including pain, fatigue, and swallowing problems.

A COTA® suspects that her supervising OTR® is falsifying treatment session documentation in order to comply with documentation deadlines. If true, this constitutes a breach of Veracity and Justice. What is the BEST next step the COTA take?

Approaching the person directly is most appropriate; it is the most respectful approach, and the COTA may be incorrect about the OTR's behavior

A COTA® is working with a client in the acute phase of Guillain-Barré syndrome. Which client action demonstrates the ability to direct care?

A client in the acute phase of Guillain-Barré syndrome may not be able to participate directly in activities; statement of the need to change position in bed reflects an awareness of needs and ability to request assistance.

An OTA student on Level II fieldwork came to the fieldwork site drunk and attempted to treat clients. The student was reported by the supervisor and found in violation of the NBCOT® Code of Conduct. What is the most severe sanction the student could receive?

Ineligibility for certification is the most severe discipline because the student would be unable to become certified as a COTA®.

What main neuromusculoskeletal feature is a client with multiple sclerosis likely to exhibit that a COTA® should consider during intervention?

Intention tremor is commonly seen in people with MS

Which role is the AOTA Ethics Commission charged with?

Issuing advisory opinions is one of several roles the AOTA Ethics Commission is charged with.

An occupational therapy practitioner has identified a situation that is causing an ethical conflict. What should the occupational therapy practitioner do next to address the ethical conflict?

Once an ethical conflict or dilemma is identified, the practitioner should affirm the situation by discussing with trusted colleagues and reviewing the Occupational Therapy Code of Ethics and state regulations. The practitioner can the determine the pros and cons of various options by analyzing factors and prepare to take the most appropriate action.

Which of the following should a COTA® consider as a likely need for a client during the early stages of Parkinson's disease?

People in the early stage of Parkinson's disease are at risk for decreased interest in social and leisure activities and resulting isolation

A statement in the Occupational Therapy Code of Ethics (2015) reads, "Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services." Which principle is this statement part of

Principle 1, Beneficence, involves the commitment to benefit others and to be concerned with the well-being and safety of service recipients.

A COTA® has discontinued occupational therapy services with a client. A month after the completion of services, the client and the COTA see each other unexpectedly at the local grocery store. They both express interest in dating the other person. They start dating within a month of this meeting at the grocery store.

Principle 2: -Nonmaleficence, states that occupational therapy personnel shall intentionally refrain from actions that cause harm. -Principle 2C states that practitioners shall avoid engaging in any sexual relationship or activity with recipients of services. Although the client and COTA are no longer in a professional relationship -Principle 2I requires the COTA to "avoid exploiting any relationship established as an occupational therapy clinician, educator, or researcher to further one's own physical, emotional, financial, political, or business interests at the expense of recipients of services, students, research participants, employees, or colleagues."

What principle of the Occupational Therapy Code of Ethics (2015) guides occupational therapy practitioners to accurately represent their credentials, qualifications, education, experience, and training to all service recipients, students, employees, research participants, and colleagues?

Principle 5, Veracity, requires accurate representation of credentials, qualifications, education, experience, and training in all forms of communication

What is the purpose of the Disciplinary Council as described in the Enforcement Procedures for the Occupational Therapy Code of Ethics and Ethics Standards?

The Disciplinary Council provides a forum for the person against whom the ethical violation charge has been made to respond to the charge. Witnesses and evidence can be presented.

A client needs a wrist orthosis. The OTA® is aware that the guidelines from the client's insurance company indicate that reimbursement is not provided for equipment and that the insurance company considers the wrist orthosis equipment. What should the OTA do in this situation?

The OTA is faced with an ethical dilemma of providing an orthosis when there is no payment for the orthosis and the client needs the orthosis. Considering the pros and cons allows the OTA to identify the positive and negative situational variables involved in making the orthosis.

An OTR® in a skilled nursing facility is responsible for upholding applicable Medicare regulations during supervision of the COTA®. Which ethical principle is the OTR upholding in this situation?

The OTR is upholding the principle of Justice, which requires occupational therapy practitioners to be aware of policies set by regulatory agencies, such as the Centers for Medicare and Medicaid Services. An OTR must provide appropriate supervision for OTA practitioners and follow policies related to reimbursement through all agencies

The Occupational Therapy Code of Ethics (2015) states, "Occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity." What principle does this statement directly relate to?

This statement is used in Principle 6, Fidelity, of the Occupational Therapy Code of Ethics (2015).

What MUST a client have in order to provide informed consent of occupational therapy services?

-A client must have sufficient knowledge for making decisions related to care. -A client must be capable of understanding information that is presented about the occupational therapy services. -A client must be able to voluntarily and freely make choices about care.

A newly certified COTA® is working a first job on an inpatient rehabilitation unit. The OTR® instructs the COTA to teach a bath bench transfer to a patient while the OTR goes to another room to evaluate a new patient. The COTA never completed a bath bench transfer before. What ethical principles should guide the student in this situation?

-Beneficence involves demonstrating concern for the safety of clients. The COTA has not established competency in completing bath bench transfers and therefore should take steps by requesting supervision and training to complete this transfer for the first time. -Nonmaleficence requires the COTA to avoid inflicting harm or injury to clients receiving occupational therapy services. If the COTA is not competent in completing a bath bench transfer, then harm may come to the client. -Justice requires that appropriate supervision be provided and that the supervision vary according to the knowledge and skill level of the OTR and the COTA. In this situation, the OTA does not have the skill level to complete this task independently.

A client is expressing concern about an intervention that is being used in the occupational therapy plan. What actions should the COTA® take in this situation?

-Occupational therapy practitioners have an obligation to clearly explain interventions that are being provided and to explore available alternative options. -All available interventions must have risk and benefits explained within reason. Information provided must be sufficient to allow the client to make a choice. -To have informed consent, clients must be allowed to ask questions, and practitioners must answer honestly. This process provides the opportunity to ensure the client's understanding of the intervention choices.

Which action relates to the ethical principle of Justice?

-Offering pro bono services relates to ensuring that clients are treated fairly and equally. -The principle of Justice requires occupational therapy practitioners to refrain from accepting gifts from clients that may influence the therapeutic relationship or have the potential to blur professional boundaries. -Referrals need to be responded to in a timely manner to ensure that clients are treated fairly.

Code of Ethics and Ethics Standards: Ethical Principles

-Principle 1, Beneficence: "Occupational therapy personal shall demonstrate a concern for the well-being and safety of the recipients of their services" -Principle 2, Nonmaleficence, states, "Occupational therapy personnel shall refrain from actions that cause harm." -Principle 3, Autonomy/ Confidentiality: "Occupational therapy personal shall respect the right of the individual to self-determination." -Principle 4, Social Justice: "Occupational therapy personal shall provide services in a fair and equitable manner" -Principle 5, Procedural Justice: "Occupational therapy personal shall comply with institutional rules, local, state, federal, and international laws and AOTA documents applicable to the profession of occupational therapy" -Principle 6, Veracity, states, "Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession." -Principle 7, Fidelity, states, "Occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity."

Why does the Occupational Therapy Code of Ethics (2015) encourage occupational therapy practitioners to use evidence-based evaluations, interventions, and therapeutic equipment whenever possible?

-Principle 1F (Beneficence) states that practitioners shall "take steps (e.g., continuing education, research, supervision, training) to ensure proficiency, use careful judgment, and weigh potential for harm when generally recognized standards do not exist in emerging technology or areas of practice." -Principle 2A (Nonmaleficence) states that practitioners shall "avoid inflicting harm or injury to recipients of occupational therapy services, students, research participants, or employees." Use of evidence from empirical research and clinical expertise to inform occupational therapy practice provides the greatest likelihood that practitioners will provide best possible care and reduce the threat of doing harm.

An OTA® is concerned about the unethical behavior of another OTA. What regulatory bodies could the OTA consider in seeking guidance about reporting unethical conduct?

-The AOTA Ethics Commission allows occupational therapy practitioners to call or write about possible violation of ethics. After discussion, a formal complaint may be made to the Ethics Commission if needed. -The state's licensure laws provide guidance to the state regulatory boards and may be able to determine whether the public is at risk as a result of a provider's unethical behaviors. -The National Board for Certification in Occupational Therapy will determine whether a practitioner's certification is in jeopardy on the basis of the unethical behavior

A COTA® has been told by the OTR® that a client is scheduled for daily occupational therapy because the department needs to increase billing units for the month. The COTA does not think that daily occupational therapy services are necessary. What actions should the COTA take in this situation?

-When a practitioner identifies an ethical dilemma, he or she should gather all relevant facts. In this situation, that would include reading the initial evaluation plan to learn more about the client's needs and the rationale for establishing a frequency of daily intervention. -Discussing a hypothetical situation with the facility's compliance officer would be an opportunity to consider additional resources, a necessary step when making ethical decisions. -Multiple courses of action are often considered when determining what to do about an ethical dilemma, and these are two possible courses of action in this situation

Code of ethics and ethics standards: core concepts

1. Altruism: The individual's ability to place the needs of others before their own 2. Equality: The desire to promote fairness and interaction with others 3. Freedom: The desire of the client must guide interventions 4. Justice: relating in a fair and impartial manner to individuals with whom they interact and respect and it here to the applicable laws and standards regarding the area of practice 5. Dignity: Treating each client respect fully and as an individual by enabling the client to engage in occupations that are meaningful regardless of level of disability 6. Truth: In all situations, occupational therapist, occupational therapy assistance, and students must provide accurate information, both in oral and written form 7. Prudence: use of clinical and ethical reasoning skills, sound judgment, and reflection to make decisions within the occupational therapy practitioners area of practice

An OTA® is working with a client in an area of practice for which the OTA has not demonstrated competence. The client requires a seating and positioning evaluation for a wheelchair. This is not an area for which the OTA has any experience. The OTA asks the supervising OTR® to assign an OTA who has experience in this area. The OTA is following which ethical standard?

Beneficence includes actions intended to benefit others. Concerns for safety for service recipients are beneficial actions. Taking care to make sure that decisions are made which relate to training and competence.

A COTA® continues to work with and charge for services with a client after all goals are met and there is no further need for occupational therapy services. The supervising OTR® discovers this and meets with the COTA to explain why this behavior is unethical. Which Occupational Therapy Code of Ethics (2015) principle best describes this situation?

Beneficence is the principle that occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. -Beneficence hold personnel accountable to integrity for goals related to treatment. -Principle 1H of the Occupational Therapy Code of Ethics (2015) states, "Occupational therapy personnel shall terminate occupational therapy services in collaboration with the service recipient or responsible party when the services are no longer beneficial."

An order came in for a hand orthosis for a new client. The OTR® who completed the evaluation asked the newly graduated COTA® to fabricate the orthosis. The new COTA had not made an orthosis on a client before and requested assistance from the supervising OTR, who is a hand therapist. Which ethical principle did the newly graduated COTA follow?

Beneficence relates to occupational therapy practitioners having concern for the safety of clients. The newly graduated COTA needed to establish a level of competence by working with the OTR to demonstrate proficient orthotic fabrication.

To ensure appropriate and professional management of ethical complaints, what does the AOTA Ethics Commission strive to do?

Confidentiality guidelines are set and strictly enforced by the Ethics Commission and are applied to all parties involved in the complaint.

A COTA® observes that a client with Parkinson's disease has fine motor difficulties when dressing. Which strategy is BEST for improving performance in dressing?

Eliminating clothing fasteners is a task modification that decreases the level of performance difficulty. This strategy is also the most readily manageable option for this client, because of the progressive loss of fine motor function.

For clients with a neurodegenerative disease who are experiencing fatigue that impedes occupational performance, which recommendation is BEST?

Environmental accommodations allow clients to maintain their current lifestyle as much as possible while preserving energy for occupational performance.

A Complainant is a person filing an ethical complaint with the AOTA Ethics Commission. What condition must a Complainant fulfill?

Established procedures for filing a complaint mandate identification in writing of the person against whom the complaint is being filed.

According the ethical principle of Justice, a COTA® is obliged to be aware of certain laws such as the Americans With Disabilities Act (ADA). A COTA who is also a rehab manager in a long-term care facility has an incoming fieldwork student who is requesting an accommodation for a disability. How should the COTA respond to the request?

Reasonable accommodation for employees with disabilities is required under the ADA, so it is appropriate to attempt to accommodate the fieldwork student. Determining whether the site can accommodate the request, consulting with management as necessary as well as any practitioners who may be affected by the decision, is the best option.

A person with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome) is having difficulty in the transition to a new adult foster care home. An OTR® and COTA® are contracted to make four home visits to assess the client and provide appropriate intervention. When the OTR and COTA arrive for the first visit and attempt to interview the client, the client angrily refuses to speak with them. Which option is the BEST response to this client's behavior?

Recipients of occupational therapy services have the right to refuse services. As noted in the principle of Autonomy in the Occupational Therapy Code of Ethics, "Occupational therapy personnel shall respect the right of the individual to self-determination" (p. 5). Because the client's foster family is also a client, it would be acceptable to ask the client for permission to meet with the foster family to gather information and provide indirect recommendations.

Which type of pressure do occupational therapy practitioners most commonly identify as leading to moral distress and organizational ethics violations?

Reimbursement constraints is one of the top ethical concerns leading to moral distress in occupational therapy practitioners. -Practitioners reported that being pressured to provide therapeutic service primarily for financial benefit rather than for the health and well-being of clients is highly distressing

When the AOTA Ethics Commission determines that unethical conduct has occurred, it typically issues a disciplinary action. Which disciplinary action does NOT require public report of conclusions and sanctions?

Reprimand is a formal expression of disapproval of conduct communicated privately by letter from the AOTA Ethics Commission.

For a client with multiple sclerosis, which compensatory cognitive strategy would BEST aid in performance of daily activities?

Spreading demanding tasks throughout the day allows for rest periods to promote cognitive ability. Clients with multiple sclerosis typically have greater cognitive abilities in the morning and after rest breaks.

A client diagnosed with amyotrophic lateral sclerosis (ALS) 2 years ago is admitted to the hospital because of worsening mobility at home. Before the hospitalization, the client was independent with ADLs but required assistance for IADLs, including cooking, shopping, and home management. Which approach is the COTA® MOST likely to use with this client in the acute care setting?

The caregiver should be trained in skills for assisting the client with ADLs because the client will require greater assistance for tasks as symptoms progress.

A participant in a research study who has provided informed consent tells the COTA® that she wants to withdraw. Which ethical principles require the COTA to bring the conversation to the attention of the primary investigator (PI)?

The ethical principle of Autonomy relates to the participant's right to end any participation in a research study for any reason. - Informed consent in research allows a person to stop participating in a research study. Because the COTA is not the PI, the principle of Fidelity would require her to communicate respectfully regarding the request with the PI. -Fidelity acknowledges that "professional relationships are greatly influenced by the complexity of the environment in which occupational therapy personnel work. Practitioners, educators, and researchers alike must consistently balance their duties to service recipients, students, research participants, and other professionals as well as to organizations that may influence decision making and professional practice." -The COTA must involve the PI to effectively balance these obligations

A client provides a gift to every person in the department, including the COTA® who worked with the client. This gift is consistent with cultural practices of the client and is valued at less than $5.00. Which ethical principle BEST helps determine whether it is appropriate for the COTA to accept the gift?

The guiding ethical principle is Principle 4, Justice. The amount of the gift is minimal, and the gift was given to everybody. It is appropriate to accept the gift. This scenario did not create a situation in which objectivity or boundaries were compromised, and the nominal amount of the gift does not "unduly influence the therapeutic relationship or have the potential to blur professional boundaries, and adhere to employer policies when offered gifts."

A client with an acquired brain injury does not have private funds to pay for skilled occupational therapy services. The client does not have access to Medicaid. As a result, the client chooses to discontinue therapy. Which ethical principle requires the practitioner to respect the client's decision?

The practitioner should help the client locate other forms of funding, but if the client is unable to secure reimbursement, the client has the right to refuse treatment secondary to the burden of cost

A client with Parkinson's disease has experienced a significant decrease in participation in activities in the home. The initial evaluation from the OTR® states that this decrease in activity is related to the client's postural instability and the caregiver's fear that the client will fall. Which intervention is BEST to restore this client's participation in home activities?

Use of specific cueing methods and clear verbal and visual instructions may facilitate improved motor movements for activity participation.

An OTA Level II fieldwork student gives an inservice to the occupational therapy staff at the fieldwork site. The next month, the OTA student attends a continuing education session that an OTR® from the site is conducting for physician assistants. The student recognizes most of the slides as being from the student's own previous presentation. No credit is given to the student or the sources the student used. Which ethical principle did the OTR® violate

Veracity relates to being fair to colleagues, such as giving credit for other's ideas and avoiding plagiarism.