Occupational Therapy Ethics

Course Description: “Occupational Therapy Ethics” was designed to help therapy professionals with the ethical dilemmas they face in the workplace. The course is designed to promote a better understanding of ethics, morals and legal behavior in the hopes of facilitating a better decision making process for professionals in ethical situations. The information also includes the AOTA Occupational Therapy Code of Ethics and Ethics Standards, the NBCOT Candidate/Certificant Code of Conduct, and the Procedures for the Enforcement of the NBCOT Candidate/Certificant Code of Conduct.

Course Author Mary Smith, RPT

Methods of Instruction: Online course available via internet

Target Audience: Occupational Therapists and Occupational Therapist Assistants

Educational Level: Intermediate

Prerequisites: None

Course Goals and Objectives: At the completion of this course, participants should be able to:

1. Define Ethics2. Define Morality3. Identify the basic similarities and differences between ethics and morals4. Differentiate between common ethical theories5. Define determinants of moral and ethical behavior6. Understand the ethical decision-making process7. Interpret and apply the AOTA’s Occupational Therapy Code of Ethics and Ethics Standards8. Interpret and apply the NBCOT Candidate/Certificant Code of Conduct9. Understand and incorporate the Procedures for the Enforcement of the NBCOT

Candidate/Certificant Code of Conduct

Criteria for Obtaining Continuing Education Credits: A score of 70% or greater on the post-test

1 of 30

DIRECTIONS FOR COMPLETING

1. Review the goals and objectives for the course.

THE COURSE:

2. Review the course material. 3. We strongly suggest printing out a hard copy of the test. Mark your

answers as you go along and then transfer them to the actual test. A printable test can be found when clicking on “View/Take Test” in your “My Account”.

4. After reading the course material, when you are ready to take the test, go back to your “My Account” and click on “View/Take Test”.

5. A grade of 70% or higher on the test is considered passing. If you have not scored 70% or higher, this indicates that the material was not fully comprehended. To obtain your completion certificate, please re-read the material and take the test again.

6. After passing the test, you will be required to fill out a short survey. After the survey, your certificate of completion will immediately appear. We suggest that you save a copy of your certificate to your computer and print a hard copy for your records.

7. You have up to one year to complete this course from the date of purchase.

8. If we can help in any way, please don’t hesitate to contact us utilizing our live chat, via email at info@advantageceus.com or by phone at 405-974-0164.

2 of 30

Occupational Therapy Ethics

Occupational Therapy should be black and white…right? You go to school, learn how to be a great therapist, graduate with the degree and then rush out to help the world. And usually, it works out that way and both patients

and therapists win. But more and more these days, well intentioned occupational therapists are running into situations where the lines between

right and wrong blur….where situations aren’t always black and white….where ethics plays a vital role….

As occupational therapists become more autonomous in their role as

healthcare providers, ethical situations are more likely to arise. This course is designed to educate therapists about ethics, to help them make good

ethical decisions and feel confident about those decisions.

What “IS” Ethics??

To better understand the concepts of occupational therapy ethics, it is good first to have an overview of the discipline of ethics. The word “ethics” is coined from the Greek word ethos which means “character” and from the Latin word mores which means “customs”. Together, they combine and define how individuals make a choice of interacting with one another. In the field of occupational therapy, the study of ethics is categorized into normative or philosophical ethics and social scientific or descriptive ethics. Philosophical ethics mainly deals with what people are supposed to do and how they should carry themselves as well as the rationality in making such decisions. Social scientific ethics on the other hand focuses on the study of human ethical behavior with empirical or social scientific tools aiming at exploring the bases of human objectives and the bases of “right” and “wrong” human deeds that enhance or hinder these goals.

The significance of ethics is evidential on several levels. First, when people work in an ethical manner, they feel better about their profession and themselves. Second, ethics builds public trust which increases credibility of professions. Third, ethics promotes business at the organizational level. Businesses that are run ethically perform better than those run in an unethical manner.

3 of 30

Breaking down the basic definitions…. The Definition of Ethics A set of principles designed to determine right or wrong conduct. A theory or a system of moral values. The study of the general nature of morals and of the specific moral choices to be made by a person; moral philosophy. The rules or standards governing the conduct of a person or the members of a profession. The Definition of Moral Being concerned with principles of right and wrong or conforming to standards of behavior and character based on those principles. There are several sub-types of morality. Types of Morality Personal: values and duties you adopt as relevant

In its first, descriptive usage, morality means a code of conduct which is held to be authoritative in matters of right and wrong. Morals are created and defined by society, philosophy, religion, or individual conscience. An example of the descriptive usage could be "common conceptions of morality have changed significantly over time."

Societal: common denominator of shared beliefs

In its second, normative and universal sense, morality refers to an ideal code of conduct, one which would be espoused in preference to alternatives by all rational people, under specified conditions. In this "prescriptive" sense of morality as opposed to the above described "descriptive" sort of sense, moral value judgments such as "murder is immoral" are made. To deny 'morality' in this sense is a position known as moral skepticism, in which the existence of objective moral "truths" is rejected.

Group: shared by the group you belong to such as work, religious, social and professional groups

4 of 30

In its third usage, 'morality' is synonymous with ethics.

When confronted with an ethical distress or dilemma that needs a decision, there are really three levels in which an ethical decision needs to be made.

1. An ethical problem is one in which the practitioner is confronted by challenges or threats to his or her moral duties and values.

2. Ethical distress occurs when practitioners know the course of action they should take, but for whatever reason, they do not take it. They may be blocked from being the kind of person that they want to be and cannot do the things that they really want to do or they feel is right. There may be institutional or financial barriers.

3. An ethical dilemma is when there are two morally correct courses of action, but they cannot both be followed at the same time.

Ethics versus Morals

People often confuse the words “ethics” and “morals” sometimes using them interchangeably. Notably though, the two words are not identical. The term morals refer to practices whereas ethics usually refers to the rationale that support or oppose such practices. In short, morals are concerned with actions and ethics with reasoning behind such actions. Ethics is usually at a higher intellectual level, more universal, and more emotionally involved than morals.

From time immemorial, man has tried to come up with philosophical bases for determining what is wrong or right. With this several ethical theories have been proposed. Some of generally accepted ethical theories are utilitarianism, social contract theory, deontological theory, ethical intuitionism, ethical egoism, natural law theory and virtue ethics.

Utilitarianism is the idea that the moral worth of an action is determined only by what it can contribute to overall utility. Its worth is its contribution to happiness as summed among all people. It is a form of consequentialism, meaning that the moral worth of an action is determined by its outcome. Utilitarianism is sometimes described by the phrase "the greatest good for the greatest number of people". It is commonly known as "the greatest happiness principle".

Social contract describes a group of theories that explains how people maintain social order. This theory states that some individuals give up their

5 of 30

rights to authority in order for society to maintain a higher and more organized social order.

Deontological theory states that all acts are either inherently good or bad, no matter what the end result is. Most deontological theorists believe that we have a duty to do what is inherently good, even if the end result or consequence is bad.

Ethical Intuitionism is described as common sense or conscience. It states that an act or decision is ruled as right or wrong, depending upon the natural intuition of the individual.

Ethical Egoism operates under the idea that each individual must make decisions based on what is in their own best interests.

Natural law theory is a philosophical and legal belief that all humans are governed by basic innate laws, or laws of nature, which are separate and distinct from laws which are legislated. It infers that natural law is akin to common sense or intuition.

Virtue ethics may be identified as the one that emphasizes the virtues, or moral character, in contrast to the other theories that emphasizes duties or rules. This theory points to how the decision could be good, charitable or benevolent.

Determinants of Ethical/Moral Behavior

There are basically four components to moral behavior - moral sensitivity, moral judgment, moral motivation and moral character. For a good ethical decision to be made, all four of these components have to be in place. None is more important than the other. All four of them have to be in place to meet the requirement of an ethical decision. 1. Moral Sensitivity Moral sensitivity is the ability to interpret the situation and project the consequences of your actions. If you do not have moral sensitivity, then you do not act ethically because it does not occur that what you are doing is going to affect anybody else. 2. Moral Judgment Moral judgment is deciding which action is right or wrong because you are able to assess how the different lines of actions that you could take will affect other people.

6 of 30

3. Moral Motivation Moral motivation prioritizes moral values over motives such as self gratification, making money, revenge, protecting your reputation or protecting your organization. 4. Moral Character This is the ability to have the perseverance, the toughness, the conviction and the courage to take action to correct something that you know is wrong. This is taking on the duty to report even if you are not required to report. It is truly the essence of professional behavior. This is the standard that we need to achieve. We need to help people understand that it is their responsibility to stop actions that might be negative for the people that they treat and for the community that we serve. 5. Moral Failure Moral failure occurs when any of these components do not happen. In order to take moral action, you have to have all four of them. It is a complex interaction.

Now that we understand all of the terminology and basic theories, we come down to a more important question. There are so many theories and rules…

The Ethical Decision-Making Process:

HOW do I go about making the right ethical decision in my every day practice???

When making ethical decisions, we need to remember the 6 Ethical principles, as they could and SHOULD direct our decisions.

(1) Autonomy

(2)

: patients have the right to make some decisions as well as we do.

Beneficence

(3)

: providing care in the best interest of the patient

Confidentiality

(4)

: respecting an individual’s right to privacy

Non malfeasance

(5)

: “do no harm”

Justice

(6)

: equity or fair treatment

Veracity: truthfulness

7 of 30

It is also important that an individual be able to answer the following questions.

(1) Test for Right versus Wrong- is it obvious?

(2) Legal test: Is it legal?

(3) “PU” test: Does it smell or feel wrong-a test of common sense/conscience

(4) Front page test: How would it look on the front page of the newspaper? Would that make you change your decision or how you feel about the situation?

(5) Mom/Dad Test: How would your parents feel if they knew what you were doing?

(6) The professional ethics test: What do the Code of Ethics, Code of Conduct say? Know your practice act and rules and regulations.

Occupational Therapy Code of Ethics (2015)

Be active in your professional organization. Realize that at times, rules and regulations change! Make sure you stay up to date at all times.

Preamble

The 2015 Occupational Therapy Code of Ethics (Code) of the American Occupational Therapy Association (AOTA) is designed to reflect the dynamic nature of the profession, the evolving health care environment, and emerging technologies that can present potential ethical concerns in research, education, and practice. AOTA members are committed to promoting inclusion, participation, safety, and well-being for all recipients in various stages of life, health, and illness and to empowering all beneficiaries of service to meet their occupational needs. Recipients of services may be individuals, groups, families, organizations, communities, or populations (AOTA, 2014b). The Code is an AOTA Official Document and a public statement tailored to address the most prevalent ethical concerns of the occupational therapy profession. It outlines Standards of Conduct the public can expect from those in the profession. It should be applied to all areas of occupational therapy and shared with relevant stakeholders to promote ethical conduct.

8 of 30

The Code serves two purposes: 1. It provides aspirational Core Values that guide members toward ethical courses of action in professional and volunteer roles, and 2. It delineates enforceable Principles and Standards of Conduct that apply to AOTA members. Whereas the Code helps guide and define decision-making parameters, ethical action goes beyond rote compliance with these Principles and is a manifestation of moral character and mindful reflection. It is a commitment to benefit others, to virtuous practice of artistry and science, to genuinely good behaviors, and to noble acts of courage. Recognizing and resolving ethical issues is a systematic process that includes analysis of the complex dynamics of situations, weighing of consequences, making reasoned decisions, taking action, and reflecting on outcomes. Occupational therapy personnel, including students in occupational therapy programs, are expected to abide by the Principles and Standards of Conduct within this Code. Personnel roles include clinicians (e.g., direct service, consultation, administration); educators; researchers; entrepreneurs; business owners; and those in elected, appointed, or other professional volunteer service. The process for addressing ethics violations by AOTA members (and associate members, where applicable) is outlined in the Code’s Enforcement Procedures (AOTA, 2014a). Although the Code can be used in conjunction with licensure board regulations and laws that guide standards of practice, the Code is meant to be a free-standing document, guiding ethical dimensions of professional behavior, responsibility, practice, and decision making. This Code is not exhaustive; that is, the Principles and Standards of Conduct cannot address every possible situation. Therefore, before making complex ethical decisions that require further expertise, occupational therapy personnel should seek out resources to assist in resolving ethical issues not addressed in this document. Resources can include, but are not limited to, ethics committees, ethics officers, the AOTA Ethics Commission or Ethics Program Manager, or an ethics consultant.

9 of 30

Core Values

The profession is grounded in seven long-standing Core Values: (1) Altruism, (2) Equality, (3) Freedom, (4) Justice, (5) Dignity, (6) Truth, and (7) Prudence. Altruism involves demonstrating concern for the welfare of others. Equality refers to treating all people impartially and free of bias. Freedom and personal choice are paramount in a profession in which the values and desires of the client guide our interventions. Justice expresses a state in which diverse communities are inclusive; diverse communities are organized and structured such that all members can function, flourish, and live a satisfactory life. Occupational therapy personnel, by virtue of the specific nature of the practice of occupational therapy, have a vested interest in addressing unjust inequities that limit opportunities for participation in society (Braveman & Bass-Haugen, 2009). Inherent in the practice of occupational therapy is the promotion and preservation of the individuality and Dignity of the client, by treating him or her with respect in all interactions. In all situations, occupational therapy personnel must provide accurate information in oral, written, and electronic forms (Truth). Occupational therapy personnel use their clinical and ethical reasoning skills, sound judgment, and reflection to make decisions in professional and volunteer roles (Prudence). The seven Core Values provide a foundation to guide occupational therapy personnel in their interactions with others. Although the Core Values are not themselves enforceable standards, they should be considered when determining the most ethical course of action.

Principles and Standards of Conduct

The Principles and Standards of Conduct that are enforceable for professional behavior include (1) Beneficence, (2) Nonmaleficence, (3) Autonomy, (4) Justice, (5) Veracity, and (6) Fidelity. Reflection on the historical foundations of occupational therapy and related professions resulted in the inclusion of Principles that are consistently referenced as a guideline for ethical decision making. Beneficence Principle 1. Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services.

10 of 30

Beneficence includes all forms of action intended to benefit other persons. The term beneficence connotes acts of mercy, kindness, and charity (Beauchamp & Childress, 2013). Beneficence requires taking action by helping others, in other words, by promoting good, by preventing harm, and by removing harm. Examples of beneficence include protecting and defending the rights of others, preventing harm from occurring to others, removing conditions that will cause harm to others, helping persons with disabilities, and rescuing persons in danger (Beauchamp & Childress, 2013). Related Standards of Conduct Occupational therapy personnel shall A. Provide appropriate evaluation and a plan of intervention for recipients of occupational therapy services specific to their needs. B. Reevaluate and reassess recipients of service in a timely manner to determine whether goals are being achieved and whether intervention plans should be revised. C. Use, to the extent possible, evaluation, planning, intervention techniques, assessments, and therapeutic equipment that are evidence based, current, and within the recognized scope of occupational therapy practice. D. Ensure that all duties delegated to other occupational therapy personnel are congruent with credentials, qualifications, experience, competency, and scope of practice with respect to service delivery, supervision, fieldwork education, and research. E. Provide occupational therapy services, including education and training, that are within each practitioner’s level of competence and scope of practice. F. 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. G. Maintain competency by ongoing participation in education relevant to one’s practice area. H. Terminate occupational therapy services in collaboration with the service recipient or responsible party when the services are no longer beneficial. I. Refer to other providers when indicated by the needs of the client. J. Conduct and disseminate research in accordance with currently accepted ethical guidelines and standards for the protection of research participants, including determination of potential risks and benefits.

11 of 30

Nonmaleficence Principle 2. Occupational therapy personnel shall refrain from actions that cause harm. Nonmaleficence “obligates us to abstain from causing harm to others” (Beauchamp & Childress, 2013, p. 150). The Principle of Nonmaleficence also includes an obligation to not impose risks of harm even if the potential risk is without malicious or harmful intent. This Principle often is examined under the context of due care. The standard of due care “requires that the goals pursued justify the risks that must be imposed to achieve those goals” (Beauchamp & Childress, 2013, p. 154). For example, in occupational therapy practice, this standard applies to situations in which the client might feel pain from a treatment intervention; however, the acute pain is justified by potential longitudinal, evidence-based benefits of the treatment. Related Standards of Conduct Occupational therapy personnel shall A. Avoid inflicting harm or injury to recipients of occupational therapy services, students, research participants, or employees. B. Avoid abandoning the service recipient by facilitating appropriate transitions when unable to provide services for any reason. C. Recognize and take appropriate action to remedy personal problems and limitations that might cause harm to recipients of service, colleagues, students, research participants, or others. D. Avoid any undue influences that may impair practice and compromise the ability to safely and competently provide occupational therapy services, education, or research. E. Address impaired practice and when necessary report to the appropriate authorities. F. Avoid dual relationships, conflicts of interest, and situations in which a practitioner, educator, student, researcher, or employer is unable to maintain clear professional boundaries or objectivity. G. Avoid engaging in sexual activity with a recipient of service, including the client’s family or significant other, student, research participant, or employee, while a professional relationship exists. H. Avoid compromising rights or well-being of others based on arbitrary directives (e.g., unrealistic productivity expectations, falsification of documentation, inaccurate coding) by exercising professional judgment and critical analysis. I. Avoid exploiting any relationship established as an occupational therapy clinician, educator, or researcher to further one’s own physical, emotional,

12 of 30

financial, political, or business interests at the expense of recipients of services, students, research participants, employees, or colleagues. J. Avoid bartering for services when there is the potential for exploitation and conflict of interest. Autonomy Principle 3. Occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent. The Principle of Autonomy expresses the concept that practitioners have a duty to treat the client according to the client’s desires, within the bounds of accepted standards of care, and to protect the client’s confidential information. Often, respect for Autonomy is referred to as the self-determination principle. However, respecting a person’s autonomy goes beyond acknowledging an individual as a mere agent and also acknowledges a person’s right “to hold views, to make choices, and to take actions based on [his or her] values and beliefs” (Beauchamp & Childress, 2013, p. 106). Individuals have the right to make a determination regarding care decisions that directly affect their lives. In the event that a person lacks decision-making capacity, his or her autonomy should be respected through involvement of an authorized agent or surrogate decision maker. Related Standards of Conduct Occupational therapy personnel shall A. Respect and honor the expressed wishes of recipients of service. B. Fully disclose the benefits, risks, and potential outcomes of any intervention; the personnel who will be providing the intervention; and any reasonable alternatives to the proposed intervention. C. Obtain consent after disclosing appropriate information and answering any questions posed by the recipient of service or research participant to ensure voluntariness. D. Establish a collaborative relationship with recipients of service and relevant stakeholders, to promote shared decision making. E. Respect the client’s right to refuse occupational therapy services temporarily or permanently, even when that refusal has potential to result in poor outcomes. F. Refrain from threatening, coercing, or deceiving clients to promote compliance with occupational therapy recommendations. G. Respect a research participant’s right to withdraw from a research study without penalty.

13 of 30

H. Maintain the confidentiality of all verbal, written, electronic, augmentative, and nonverbal communications, in compliance with applicable laws, including all aspects of privacy laws and exceptions thereto (e.g., Health Insurance Portability and Accountability Act, Family Educational Rights and Privacy Act). I. Display responsible conduct and discretion when engaging in social networking, including but not limited to refraining from posting protected health information. J. Facilitate comprehension and address barriers to communication (e.g., aphasia; differences in language, literacy, culture) with the recipient of service (or responsible party), student, or research participant. Justice Principle 4. Occupational therapy personnel shall promote fairness and objectivity in the provision of occupational therapy services. The Principle of Justice relates to the fair, equitable, and appropriate treatment of persons (Beauchamp & Childress, 2013). Occupational therapy personnel should relate in a respectful, fair, and impartial manner to individuals and groups with whom they interact. They should also respect the applicable laws and standards related to their area of practice. Justice requires the impartial consideration and consistent following of rules to generate unbiased decisions and promote fairness. As occupational therapy personnel, we work to uphold a society in which all individuals have an equitable opportunity to achieve occupational engagement as an essential component of their life. Related Standards of Conduct Occupational therapy personnel shall A. Respond to requests for occupational therapy services (e.g., a referral) in a timely manner as determined by law, regulation, or policy. B. Assist those in need of occupational therapy services to secure access through available means. C. Address barriers in access to occupational therapy services by offering or referring clients to financial aid, charity care, or pro bono services within the parameters of organizational policies. D. Advocate for changes to systems and policies that are discriminatory or unfairly limit or prevent access to occupational therapy services. E. Maintain awareness of current laws and AOTA policies and Official Documents that apply to the profession of occupational therapy.

14 of 30

F. Inform employers, employees, colleagues, students, and researchers of applicable policies, laws, and Official Documents. G. Hold requisite credentials for the occupational therapy services they provide in academic, research, physical, or virtual work settings. H. Provide appropriate supervision in accordance with AOTA Official Documents and relevant laws, regulations, policies, procedures, standards, and guidelines. I. Obtain all necessary approvals prior to initiating research activities. J. Refrain from accepting gifts that would unduly influence the therapeutic relationship or have the potential to blur professional boundaries, and adhere to employer policies when offered gifts. K. Report to appropriate authorities any acts in practice, education, and research that are unethical or illegal. L. Collaborate with employers to formulate policies and procedures in compliance with legal, regulatory, and ethical standards and work to resolve any conflicts or inconsistencies. M. Bill and collect fees legally and justly in a manner that is fair, reasonable, and commensurate with services delivered. N. Ensure compliance with relevant laws and promote transparency when participating in a business arrangement as owner, stockholder, partner, or employee. O. Ensure that documentation for reimbursement purposes is done in accordance with applicable laws, guidelines, and regulations. P. Refrain from participating in any action resulting in unauthorized access to educational content or exams (including but not limited to sharing test questions, unauthorized use of or access to content or codes, or selling access or authorization codes). Veracity Principle 5. Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession. Veracity is based on the virtues of truthfulness, candor, and honesty. The Principle of Veracity refers to comprehensive, accurate, and objective transmission of information and includes fostering understanding of such information (Beauchamp & Childress, 2013). Veracity is based on respect owed to others, including but not limited to recipients of service, colleagues, students, researchers, and research participants. In communicating with others, occupational therapy personnel implicitly promise to be truthful and not deceptive. When entering into a therapeutic or research relationship, the recipient of service or research

15 of 30

participant has a right to accurate information. In addition, transmission of information is incomplete without also ensuring that the recipient or participant understands the information provided. Concepts of veracity must be carefully balanced with other potentially competing ethical principles, cultural beliefs, and organizational policies. Veracity ultimately is valued as a means to establish trust and strengthen professional relationships. Therefore, adherence to the Principle of Veracity also requires thoughtful analysis of how full disclosure of information may affect outcomes. Related Standards of Conduct Occupational therapy personnel shall A. Represent credentials, qualifications, education, experience, training, roles, duties, competence, contributions, and findings accurately in all forms of communication. B. Refrain from using or participating in the use of any form of communication that contains false, fraudulent, deceptive, misleading, or unfair statements or claims. C. Record and report in an accurate and timely manner and in accordance with applicable regulations all information related to professional or academic documentation and activities. D. Identify and fully disclose to all appropriate persons errors or adverse events that compromise the safety of service recipients. E. Ensure that all marketing and advertising are truthful, accurate, and carefully presented to avoid misleading recipients of service, research participants, or the public. F. Describe the type and duration of occupational therapy services accurately in professional contracts, including the duties and responsibilities of all involved parties. G. Be honest, fair, accurate, respectful, and timely in gathering and reporting fact-based information regarding employee job performance and student performance. H. Give credit and recognition when using the ideas and work of others in written, oral, or electronic media (i.e., do not plagiarize). I. Provide students with access to accurate information regarding educational requirements and academic policies and procedures relative to the occupational therapy program or educational institution. J. Maintain privacy and truthfulness when utilizing telecommunication in delivery of occupational therapy services.

16 of 30

Fidelity Principle 6. Occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity. The Principle of Fidelity comes from the Latin root fidelis, meaning loyal. Fidelity refers to the duty one has to keep a commitment once it is made (Veatch, Haddad, & English, 2010). In the health professions, this commitment refers to promises made between a provider and a client or patient based on an expectation of loyalty, staying with the patient in a time of need, and compliance with a code of ethics. These promises can be implied or explicit. The duty to disclose information that is potentially meaningful in making decisions is one obligation of the moral contract between provider and client or patient (Veatch et al., 2010). Whereas respecting Fidelity requires occupational therapy personnel to meet the client’s reasonable expectations, the Principle also addresses maintaining respectful collegial and organizational relationships (Purtilo & Doherty, 2011). 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. Related Standards of Conduct Occupational therapy personnel shall A. Preserve, respect, and safeguard private information about employees, colleagues, and students unless otherwise mandated or permitted by relevant laws. B. Address incompetent, disruptive, unethical, illegal, or impaired practice that jeopardizes the safety or well-being of others and team effectiveness. C. Avoid conflicts of interest or conflicts of commitment in employment, volunteer roles, or research. D. Avoid using one’s position (employee or volunteer) or knowledge gained from that position in such a manner as to give rise to real or perceived conflict of interest among the person, the employer, other AOTA members, or other organizations. E. Be diligent stewards of human, financial, and material resources of their employers, and refrain from exploiting these resources for personal gain.

17 of 30

F. Refrain from verbal, physical, emotional, or sexual harassment of peers or colleagues. G. Refrain from communication that is derogatory, intimidating, or disrespectful and that unduly discourages others from participating in professional dialogue. H. Promote collaborative actions and communication as a member of interprofessional teams to facilitate quality care and safety for clients. I. Respect the practices, competencies, roles, and responsibilities of their own and other professions to promote a collaborative environment reflective of interprofessional teams. J. Use conflict resolution and internal and alternative dispute resolution resources as needed to resolve organizational and interpersonal conflicts, as well as perceived institutional ethics violations. K. Abide by policies, procedures, and protocols when serving or acting on behalf of a professional organization or employer to fully and accurately represent the organization’s official and authorized positions. L. Refrain from actions that reduce the public’s trust in occupational therapy. M. Self-identify when personal, cultural, or religious values preclude, or are anticipated to negatively affect, the professional relationship or provision of services, while adhering to organizational policies when requesting an exemption from service to an individual or group on the basis of conflict of conscience.

NBCOT Candidate/Certificant Code of Conduct

Preamble

The National Board for Certification in Occupational Therapy, Inc. ("NBCOT," formerly known as “AOTCB”) is a professional organization that supports and promotes occupational therapy practitioner certification. This Candidate/Certificant Code of Conduct enables NBCOT to define and clarify the professional responsibilities for present and future NBCOT certificants, i.e., OCCUPATIONAL THERAPIST REGISTERED OTR (OTR) henceforth OTR, and CERTIFIED OCCUPATIONAL THERAPY ASSISTANT COTA (COTA) henceforth COTA.

It is vital that NBCOT certificants conduct their work in a professional manner to earn and maintain the confidence and respect of recipients of occupational therapy, colleagues, employers, students, and the public.

As certified professionals in the field of occupational therapy, NBCOT certificants will at all times act with integrity and adhere to high standards for personal and professional conduct, accept responsibility for their actions, both personally and professionally, continually seek to enhance their

18 of 30

professional capabilities, practice with fairness and honesty, abide by all federal, state, and local laws and regulations, and encourage others to act in a professional manner consistent with the certification standards and responsibilities set forth below.

Where the term "certificant" is used, the term "applicant or candidate" is included in its scope.

Principle 1

Certificants shall provide accurate and truthful representations to NBCOT concerning all information related to aspects of the Certification Program, including, but not limited to, the submission of information:

• On the examination and certification renewal applications, and renewal audit form;

• Requested by NBCOT for a disciplinary action situation or

• Requested by NBCOT concerning allegations related to:

Test security violations and/or disclosure of confidential examination material content to unauthorized parties;

Misrepresentations by a certificant regarding his/her credential(s) and/or education;

The unauthorized use of NBCOT’s intellectual property, certification marks, and other copyrighted materials, including all NBCOT exam preparation tools e.g. practice exams.

Principle 2

Certificants who are the subject of a complaint shall cooperate with NBCOT concerning investigations of violations of the NBCOT Practice Standards, including the collection of relevant information.

Principle 3

Certificants shall be accurate, truthful, and complete in any and all communications, direct or indirect, with any client, employer, regulatory agency, or other parties as relates to their professional work, education, professional credentials, research and contributions to the field of O.T.

19 of 30

Principle 4

Certificants shall comply with state and/or federal laws, regulations, and statutes governing the practice of occupational therapy.

Principle 5

Certificants shall not have been convicted of a crime, the circumstances of which substantially relate to the practice of occupational therapy or indicate an inability to engage in the practice of occupational therapy safely and/or competently.

Principle 6

Certificants shall not engage in behavior or conduct, lawful or otherwise that causes them to be, or reasonably perceived to be, a threat or potential threat to the health, well-being, or safety of recipients or potential recipients of occupational therapy services.

Principle 7

Certificants shall not engage in the practice of occupational therapy while one’s ability to practice is impaired due to chemical (i.e., legal and/or illegal) drug or alcohol abuse.

Principle 8 Certificants shall not electronically post personal health information or anything, including photos, that may reveal a patient’s/client’s identity or personal or therapeutic relationship. (All statements, regardless of intent, about a patient/client can potentially contain sufficient information for a member of a community to recognize the patient/client, thus violating the state and/or federal law (i.e. Health Insurance Portability and Accountability Act (HIPAA).

20 of 30

Procedures for the Enforcement of the NBCOT Candidate/Certificant Code of Conduct

SECTION A. Preamble

In exercising its responsibility for promoting and maintaining standards of professional conduct in the practice of occupational therapy and in order to protect the public from those practitioners whose behavior falls short of these standards, the National Board for Certification in Occupational Therapy, Inc. (“NBCOT,” formerly known as “AOTCB”) has adopted a Candidate/Certificant Code of Conduct. The NBCOT has adopted these procedures for resolving issues arising under the Candidate/Certificant Code of Conduct with respect to persons who have been certified by the NBCOT or who have applied for such certification. These procedures are intended to enable the NBCOT, through its Qualifications and Compliance Review Committee (“QCRC”), comprised of both professional and public members, QCRC Chair, (or Co-Chair when Chair is unavailable) and Staff to act fairly in the performance of its responsibilities to the public as a certifying agency, and to ensure that the rights of candidates and certificants are protected.

SECTION B. Basis for Sanction

A violation of the Candidate/Certificant Code of Conduct provides basis for action and sanction under these Procedures.

SECTION C. Sanctions

1. Violations of the Candidate/Certificant Code of Conduct may result in one or more of the following sanctions:

a. Ineligibility for certification, which means that an individual is barred from becoming certified by the NBCOT, either indefinitely or for a certain duration.

b. Reprimand, which means a formal expression of disapproval, which shall be retained in the certificant’s file, but shall not be publicly announced.

c. Censure, which means a formal expression of disapproval which is publicly announced.

d. Probation, which means continued certification is subject to fulfillment of specified conditions, e.g., monitoring, education, supervision, and/or counseling.

21 of 30

e. Suspension, which means the loss of certification for a certain duration, after which the individual may be required to apply for reinstatement.

f. Revocation, which means permanent loss of certification.

2. All sanctions other than reprimand shall be announced publicly, in accordance with Section D.9. All sanctions other than reprimand shall be disclosed in response to inquiries in accordance with Section D.9.

SECTION D. Procedures For The Enforcement of The Candidate/Certificant Code of Conduct

1. Jurisdiction

The NBCOT has jurisdiction over all individuals who have been certified as an OCCUPATIONAL THERAPIST REGISTERED OTR (OTR) henceforth OTR, or CERTIFIED OCCUPATIONAL THERAPY ASSISTANT COTA (COTA) henceforth COTA, or who have applied for certification, or have applied for Occupational Therapist Eligibility Determination (OTED) to take the NBCOT Certification Examination for OTR. In addition, NBCOT has jurisdiction over all individuals who have applied for an Early Determination Review to determine eligibility to take the Certification Examination for OTR or COTA; Jurisdiction, in this case, is for the limited purpose of acting upon a request for an Early Determination.

2. Initiation of the Review Process

The NBCOT Staff ("Staff") shall initiate the process upon receipt by the NBCOT of information indicating that an individual subject to NBCOT’s jurisdiction may have violated the Candidate/Certificant Code of Conduct. Receipt of such information shall be considered a complaint for the purposes of these procedures, regardless of the source.

3. Staff Investigation and Action

a. Staff shall evaluate all complaints and determine whether to dismiss the case or propose a sanction, as deemed appropriate.

b. Staff may review any evidence, which it deems appropriate and relevant.

c. If Staff determines that the evidence does not support the allegation(s), no file shall be opened and the complainant shall be notified of the Staff’s decision.

22 of 30

d. If the complaint has also been made to the regulatory authority but no decision has been rendered, Staff may stay action pending a decision by the regulatory authority.

e. When a regulatory authority has imposed disciplinary action and Staff determines that the evidence does support the allegation(s) and the matter should be reviewed by NBCOT, the subject of the complaint shall be notified. This notification shall be in writing and shall include a brief description of the The subject of the complaint shall have thirty (30) days from the date notification is sent to respond in writing to the complaint. The Staff may extend this period up to an additional thirty (30) days upon request, provided sufficient justification for the extension is given.

f. When a regulatory authority has not imposed disciplinary action, (such as in the case of an OTED applicant, Early Determination Review, exam candidate who has responded affirmatively on the examination application to a character question or a third party complaint) Staff has the discretion to gather information in order to either dismiss the case, impose one or more sanctions, or refer to the QCRC for further review.

g. Upon completion of its investigation, Staff may take action based on the evidence and violation of NBCOT guidelines. Staff shall either:

i. Dismiss the case due to insufficient evidence, the matter being insufficiently serious, or other reasons as may be warranted; or

ii. Notify the subject of the complaint that NBCOT will not pursue further action against the subject’s certification due to appropriate action taken by the state; or

iii. Notify the subject of the complaint of the proposed sanction in writing. When disciplinary action is proposed, the subject of the complaint shall have thirty (30) days from the date notification is sent to accept the sanction or request a hearing in writing. Staff may extend this period up to an additional thirty (30) days upon request, provided sufficient justification for the extension is given.

h. Staff will review with QCRC chair all proposals for Revocation or Ineligibility for Certification prior to sending notification to the subject.

i. Staff will advise the QCRC Chair, on a periodic basis, of all imposed sanctions.

23 of 30

j. If any sanction other than reprimand is imposed, public notice may be given in accordance with Section D. 9 of these procedures.

4. Voluntary Forfeiture

The subject of a complaint may voluntarily forfeit his or her certification. This forfeiture must be submitted in writing and can be made, at any time, while the complaint is either being reviewed or when disciplinary action has been taken by the NBCOT but the terms of the sanction remain incomplete.

Staff will advise the Qualifications and Compliance Review Committee (QCRC) Chair of any voluntary forfeiture.

If the subject requests reinstatement of certification, after voluntary forfeiture, the subject must meet all of the following requirements:

a. submit reinstatement of certification request in writing,

b. satisfy current certification examination eligibility requirements (including academic and fieldwork requirements),

c. re-take and pass the national certification examination and

d. comply with proposed sanction agreement and/or other informational requests, which will be resumed upon request to regain certification.

If the subject’s certification is voluntarily forfeited, public notice may be given in accordance with Section D. 9 of these procedures.

5.

Individuals who are non-responsive on a timely basis to NBCOT investigative inquiries will have their certification automatically suspended for a period of up to three (3) years and during such period, CANNOT a) identify themselves to the public as an OCCUPATIONAL THERAPIST REGISTERED (OTR) or CERTIFIED OCCUPATIONAL THERAPY ASSISTANT (COTA) or b) use the OTR or COTA credential after their name. If no response is received within the suspension period, NBCOT certification shall automatically be revoked.

Failure to Respond to Investigative Inquiry

If the subject requests to be reinstated during the suspension, the subject shall:

a. submit reinstatement of certification request in writing,

24 of 30

b. satisfy current certification renewal requirements,

c. cooperate with and provide written response and supporting documentation to the NBCOT proposed sanction and/or other informational requests and

d. provide documentation by the state board confirming the current status of subject’s license upon request.

Upon receipt of a request to satisfy these requirements, the complaint will be handled in accordance with these Enforcement procedures, except that NBCOT certification status will remain in suspended status until the matter is resolved.

6. Procedures for the Sanction Agreement Letter

Upon receipt of the proposed sanction letter, the subject may either:

a. Accept the sanction as proposed and thereby waive his/her right to a hearing. To accept the sanction, the subject must sign, date and return the sanction letter to NBCOT. Upon the subject's acceptance of the sanction agreement, the qualifications and compliance process shall be considered closed. The public notification standards of Section D.9 are applicable if the settlement contains a sanction that warrants such announcement be made; or

b. Not accept the sanction as proposed and request a hearing before the QCRC. Request for a hearing must be submitted by the subject in writing. Hearing requests must include subject’s reasons for requesting a hearing and may also include any additional information or documentation which the subject wishes to provide in support of his/her position.

c. If the subject fails to respond to the sanction agreement letter, within thirty (30) days after the agreement has been sent to the subject, conditions and terms of the proposed agreement take effect immediately.

Prior to the hearing:

i. Staff shall prepare a case report of its review to the Hearing Panel.

ii. The report shall include any written responses, or other materials submitted by the subject or any other individual in relation to the complaint. A copy of the report shall be provided to the subject at least thirty (30) days prior to the hearing.

25 of 30

iii. Additional information may be requested by the Hearing Panel prior to the hearing.

At the hearing:

i. The subject of the complaint may be represented at the hearing by his/her legal counsel, or any other individual of his or her choosing.

ii. The subject of the complaint shall be solely responsible for all of his/her own expenses related to the hearing. Hearings can be conducted via teleconference call or in person at the sole discretion of the QCRC. Should the subject cancel the hearing, he/she must notify the QCRC of the cancellation no less than fifteen (15) days prior to the hearing date. Should the subject cancel the hearing within fifteen (15) days of the hearing date or not appear at the scheduled hearing, all costs associated with the preparation of the hearing shall be paid by the subject (e.g. court reporting fees, teleconference fees, hearing manual preparation fees).

iii. The subject of the complaint shall provide the QCRC with any and all materials he/she may wish to include for the hearing no less than fifteen (15) days prior to the hearing date.

Following the hearing, Staff shall notify (in writing) the complainant and the subject of the complaint of the QCRC’s decision within thirty (30) days of the decision. The decision shall take effect immediately unless otherwise provided by the QCRC.

7. Appeals Process

Within thirty (30) days after the notification of the QCRC’s decision, any individual(s) sanctioned by the QCRC at the hearing may appeal the hearing decision to the NBCOT Directors. A notice of appeal, which must be in writing and signed by the subject, shall be sent by the subject to the NBCOT Chairperson in care of the President/Chief Executive Officer. The basis for the appeal shall be fully explained in this notice.

The Chairperson of the Board of Directors shall form a three (3) person Appeals Panel within 30 days after receipt of the notice of appeal. At least one (1) member of the Appeals Panel shall be a member of the QCRC who did not serve on the Hearing Panel. No member of the QCRC who participated in the hearing shall serve on the Appeals Panel nor shall the QCRC Chair serve on the Appeals Panel if the Chair participated in the decision to offer a proposed sanction. Two-three members of the Board of

26 of 30

Directors will be selected by the Chairperson of the Board of Directors to fill out the Panel.

An appeal must relate to evidence, issues and procedures that are part of the record of the QCRC hearing and decision. The appeal may also address the substance of the disciplinary action. However, the Panel may in its discretion consider additional evidence.

Within fifteen (15) days after the notice of appeal is received by the Appeals Panel, the Panel shall provide the subject with an opportunity to schedule an appeals hearing. The subject may be represented at the hearing by legal counsel or any other individual of his/her choosing. The subject shall be solely responsible for all of his/her own expenses related to the hearing.

Within fifteen (15) days after the appeals hearing or if the subject elects not to request a formal hearing, the Panel shall decide the appeal and notify the Chairperson of its decision.

The Appeals Panel may either:

a. Affirm the QCRC’s sanction agreement;

b. Deny the QCRC’s sanction agreement;

c. Refer the case back to the Staff for further investigation and resolution with full right of appeal; or

d. Modify the QCRC’s sanction agreement, but not in a manner that would be more adverse to the subject.

The Chairperson shall promptly notify the subject of the Appeals Panel’s decision. The decision of the Appeals Panel shall be final.

8. Cooperation with NBCOT Enforcement Procedures

Failure to respond to any aspect of the Enforcement Procedures, will be considered a violation of the Candidate/Certificant Code of Conduct, Principle 2, and is sufficient grounds for the imposition of sanction by the NBCOT.

9. Announcement of Sanction

If an individual’s certification status is voluntarily forfeited, suspended or revoked, or he/she is censured or placed on probation, occupational therapy state regulatory bodies shall be notified and an announcement included in

27 of 30

NBCOT’s online resources and in one or more publications of general circulation to persons engaged or otherwise interested in the profession of occupational therapy. The NBCOT may also disclose its final decision, including ineligibility for certification, to others as it deems appropriate, including, but not limited to, persons inquiring about the status of an individual’s certification, employers, third party payers and the general public.

10. Notification

All notifications referred to in these procedures shall be in writing and if the subject does not respond, shall be by confirmation of signature, return receipt mail, unless otherwise indicated. Subjects of complaints who live outside of the U.S. may be given additional time to respond to any notifications they are sent, as determined by the Staff in its discretion.

11. Records and Reports

At the completion of this procedure, all records and reports shall be returned to the Staff. The complete files in the qualifications and compliance review proceedings shall be maintained.

12. Expedited Action

The NBCOT may expedite a matter by shortening any notice or response period provided for under these procedures if the responsible party determines in its sole discretion that shortening the period is appropriate in order to protect against the possibility of harm to recipients of occupational therapy services. In matters where the severity of the allegations and evidence provided warrant such action in order to protect the public, the NBCOT may authorize immediate suspension/revocation of certification. The subject will be duly notified of the action and given fifteen (15) days to contest the suspension or revocation.

13. Standard Of Proof

The NBCOT shall take disciplinary action against an individual only where there is clear and convincing evidence of a violation of the Candidate/Certificant Code of Conduct.

28 of 30

14.

The NBCOT recognizes the definition of disability as defined by the Americans with Disabilities Act (ADA) and acknowledges the provisions and protections of the Act. The NBCOT shall offer hearings related to qualifications and compliance review or the appeals process in a site and manner, which is architecturally accessible to persons with disabilities or offer alternative arrangements for such individuals.

Accommodations

An individual with a documented disability may request accommodations for a hearing by providing reasonable advance notice to the NBCOT of his or her disability and of the modifications or aids needed at the hearing at his or her own expense.

15. Amendment to Procedures

These procedures may be amended at any time by the NBCOT Directors.

Conclusion

In today's healthcare settings it is imperative that we as clinicians, provide the highest level of care, both ethically and professionally. Not because we have to, but because we should and our patients both deserve and expect it from us. Continually furthering our knowledge base, not only clinically, but ethically and through a better understanding of our state laws and rules, is paramount in achieving the highest level of care for our patients. Stating that you are an occupational therapist is only part of the equation. Understanding and applying all facets of the profession is the true key to success.

29 of 30

References

Barnitt, R. (1998). Ethical dilemmas in Occupational Therapy and Physical Therapy: A Survey of Practitioners in the UK National Health Service.

Journal of Medical Ethics. 3(24): 193

Boylan, M. (2000). Basic Ethics.

Englewood Cliffs, NJ: Prentice-Hall

Delany CM. (2008). Making a difference: incorporating theories of autonomy into models of informed consent.

Journal of Medical Ethics 34(9):3

Driver J. (2007). Ethics, the fundamentals.

Duncan P. (2010).

Oxford, UK: Blackwell Publishing Ltd

Values, Ethics & Health Care.

London: SAGE Publications Ltd

Gabard, Donald L. (2003). Physical Therapy Ethics.

University, Orange County: F.A. Davis Company.

Kirsch, N., Iglarsh, A. (2006). Ethical Decision Making to Avoid Disciplinary Action.

Federation Forum Magazine. 22:1

Marietta C. McGuire AL. (2009) Currents in contemporary ethics.

Journal of Law, Medicine & Ethics. 37(2):369-74

Purtilo, R. B. (2005)

New respect for respect in ethics education: In Educating for Moral Action.

A Sourcebook in Health and Rehabilitation Ethics. F.A. Davis Company.

Venglar, M., Theall, M. (2007). Case-Based Ethics Education in Physical Therapy.

The Journal of Scholarship of Teaching and Learning. 7:1

Thiroux, J.P. (1995). Ethics: Theory and Practice

. 5th ed. Englewood

http://www.aota.org/-/media/Corporate/Files/Practice/Ethics/Code-of-Ethics.pdf

http://www.nbcot.org/procedures-for-enforcement

30 of 30