Code of Ethics

The American Occupational Therapy Association (AOTA) Occupational Therapy Code of Ethics and Ethics Standards (2010) ("Code and Ethics Standards") is a public statement of principles used to promote and maintain high standards of conduct within the profession.

Occupational Therapy Code of Ethics (2015)

 Preamble

 The 2015 Occupational Therapy Code of Ethics (Code) of the American Occupational Therapy Association (AOTA) is designed to reflect the dynamic natureof theprofession, the evolving health care environment, and emerging technologies that can present potential ethical concerns in research, education, andpractice. 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 servicetomeet their occupational needs. Recipients of services maybe individuals, groups,families, organizations, communities,orpopulations (AOTA, 2014b).

The Code is an AOTAOfficial Document and a public statement tailored to address themost prevalent ethical concerns of the occupational therapy profession. It outlines Standards of Conduct the public can expect from thosein the profession.It should be applied to all areas of occupational therapy and shared with relevant stakeholders to promote ethical conduct.

 The Code serves two purposes:

  1. It provides aspirational CoreValues that guidemembers towardethical courses of action in professional and volunteer roles,and
  1. 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 acommitment 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 analysisof the complexdynamics of situations, weighingof consequences, making reasoneddecisions, taking action, and reflecting on outcomes. Occupational therapypersonnel, includingstudents in occupational therapy programs, are expected to abide bythe Principlesand Standards of Conduct within this Code. Personnel roles include clinicians (e.g., direct service, consultation, administration); educators; researchers; entrepreneurs; business owners; and thosein elected,appointed, orother professional volunteer service.

Theprocess for addressingethics violations byAOTAmembers (and associatemembers, where applicable) is outlined in the Code’s Enforcement Procedures (AOTA, 2014a).

Although the Codecan beusedin conjunction with licensureboard regulations and laws that guidestandards ofpractice, the Codeis meant tobea free-standingdocument, guidingethical dimensions of professional behavior, responsibility,practice,and decisionmaking. This Codeis not exhaustive; that is, thePrinciples andStandards of Conduct cannot address everypossible situation. Therefore, beforemakingcomplexethical decisions that requirefurther expertise, occupational therapypersonnel should seek out resources to assist in resolvingethical issues not addressed in this document. Resources can include, but arenot limited to, ethics committees,

ethics officers, theAOTA Ethics Commission orEthics Program Manager, or an ethics consultant.

CoreValues

Theprofession isgrounded in seven long-standingCoreValues: (1) Altruism, (2)Equality, (3) Freedom, (4)Justice, (5)Dignity, (6)Truth, and (7) Prudence.Altruism involves demonstrating concernforthe welfareof others.Equality refers to treating allpeople impartiallyandfreeof bias. Freedomand personal choiceareparamountin a profession in whichthe values and desires ofthe clientguide ourinterventions.Justiceexpresses astatein which diverse communities are inclusive; diverse communities areorganized andstructured such thatallmembers canfunction, flourish, and liveasatisfactorylife. Occupational therapypersonnel, byvirtue ofthe specific natureof thepracticeofoccupational therapy, haveavested interest in addressingunjust inequities that limitopportunities forparticipationin society(Braveman& Bass-Haugen, 2009).

Inherent in the practiceof occupational therapyisthe promotion and preservation ofthe individualityandDignity ofthe client, bytreating himor her with respect in allinteractions.In allsituations, occupational therapypersonnel must provide accurate information in oral, written, and electronic forms (Truth). Occupational therapypersonnel use theirclinical and ethical reasoningskills, sound judgment, andreflection to makedecisions in professional and volunteer roles (Prudence).

Theseven CoreValues providea foundation to guide occupational therapypersonnel in their interactions with others.Although the CoreValues arenot themselvesenforceablestandards, theyshould beconsidered when determiningthemostethical courseofaction.

Principlesand Standardsof Conduct

ThePrinciples andStandards ofConduct that areenforceableforprofessional behavior include (1)Beneficence, (2)Nonmaleficence, (3) Autonomy, (4)Justice, (5)Veracity, and (6) Fidelity. Reflection on the historicalfoundations of occupational therapyandrelatedprofessions resulted in theinclusion ofPrinciples that areconsistentlyreferenced asaguidelinefor ethical decision making.

Beneficence

Principle 1. Occupational therapy personnel shall demonstratea concern for thewell-being andsafety ofthe recipients oftheir services.

Beneficenceincludesallforms of action intendedto benefit other persons. Theterm beneficence connotesacts of mercy, kindness,andcharity(Beauchamp& Childress, 2013). Beneficencerequires takingaction byhelpingothers, in other words, bypromoting good, by preventingharm,and byremovingharm. Examples of beneficenceincludeprotecting and defendingthe rights of others, preventingharm from occurringto others, removingconditions that willcause harm to others, helpingpersons with disabilities, and rescuingpersons in danger (Beauchamp &Childress;, 2013).

Related Standards of Conduct

Occupational therapy personnel shall

  1. Provide appropriateevaluation and aplan ofintervention for recipients ofoccupational therapyservices specificto their needs.

B. Reevaluateand reassess recipients of servicein a timelymanner to determinewhether goals arebeing achievedand whetherinterventionplans should be revised.

  1. Use, to the extent possible, evaluation, planning, intervention techniques,assessments, and therapeutic equipment that are evidencebased, current,and within the recognized scopeof occupational therapypractice.
  1. Ensurethat allduties delegated to otheroccupational therapypersonnel are congruent with credentials, qualifications, experience, competency, and scopeof practicewith respect to servicedelivery,supervision, fieldworkeducation, and research.
  1. Provideoccupational therapyservices, includingeducation and training, that arewithin

each practitioner’s levelof competence and scopeof practice.

F. Takesteps (e.g., continuingeducation, research, supervision, training) to ensure proficiency, use careful judgment, andweigh potential forharmwhengenerally recognized standards donot existin emergingtechnologyorareas of practice.

  1. Maintain competencybyongoingparticipation in education relevant to one’s practice area.
  1. Terminate occupational therapyservices in collaboration withthe service recipient or responsible partywhen the services areno longerbeneficial.

I.           Refer to otherproviderswhen indicated bythe needs of the client.

J.           Conduct and disseminate research in accordancewith currentlyaccepted ethical guidelines and standardsforthe protection of research participants, including determination ofpotential risks and benefits.

Nonmaleficence

Principle 2. Occupational therapy personnel shallrefrainfromactionsthat causeharm.

Nonmaleficence“obligates us to abstain from causingharm to others”(Beauchamp& Childress, 2013, p. 150). ThePrincipleof Nonmaleficence also includes anobligation to not imposerisks of harm even if thepotential risk is without malicious or harmful intent. This Principle often is examinedunder thecontext of due care. Thestandard ofdue care“requires

that the goals pursued justifythe risksthat must beimposedto achievethosegoals” (Beauchamp

&Childress;, 2013, p. 154). Forexample, in occupational therapypractice,this standard applies

to situations in which the client might feel pain from a treatment intervention; however, theacute pain is justified bypotential longitudinal, evidence-based benefits of thetreatment.

Related Standards ofConduct

Occupational therapy personnel shall

  1. Avoid inflictingharm orinjuryto recipients of occupational therapyservices, students, research participants, oremployees.

B. Avoid abandoningthe servicerecipient byfacilitatingappropriate transitions when unable to provide services for anyreason.

  1. Recognize and take appropriate action to remedypersonal problems and limitations that might cause harm to recipients of service,colleagues, students, research participants, or others.
  1. Avoid anyundueinfluences that mayimpair practice and compromisetheabilityto safelyandcompetentlyprovideoccupational therapyservices, education, orresearch.
  2. Address impaired practice and when necessaryreport to the appropriateauthorities. F. Avoid dual relationships, conflicts of interest, andsituations in which apractitioner,

educator, student, researcher, or employer is unableto maintain clear professional boundaries or objectivity.

  1. Avoid engagingin sexual activitywith a recipientof service, includingtheclient’s family orsignificant other, student, research participant, or employee, whileaprofessional relationship existst.
  1. Avoid compromisingrights or well-beingof others based on arbitrarydirectives (e.g., unrealisticproductivityexpectations, falsification ofdocumentation, inaccurate coding) byexercisingprofessional judgment and critical analysis.

I.           Avoid exploitinganyrelationship established as an occupational therapyclinician, educator, or researcher tofurtherone’s own physical, emotional, financial, political, or business interestsat theexpense of recipients of services, students, researchparticipants, employees, or colleagues.

J.           Avoid barteringfor services when thereis thepotential for exploitation and conflict of interest.

Autonomy

Principle 3. Occupational therapy personnel shallrespect theright oftheindividual to self- determination, privacy,confidentiality, andconsent.

ThePrincipleof Autonomyexpresses the conceptthat practitioners haveadutyto treat the client accordingto theclient’sdesires, within thebounds of accepted standards ofcare,and to protect the client’sconfidential information. Often, respect for Autonomyis referred to as the self-determination principle. However, respecting aperson’sautonomygoes beyond acknowledgingan individual as amereagent andalso acknowledges a person’s right“to hold

views, to make choices, and to take actions basedon [his or her]values and beliefs”(Beauchamp

&Childress;, 2013, p. 106).Individuals havetheright to makeadeterminationregardingcare decisions that directlyaffect their lives.In theevent that a person lacks decision-making

capacity, his or her autonomyshould berespectedthrough involvement of an authorized agent or surrogate decisionmaker.

Related Standards ofConduct

Occupational therapy personnel shall

  1. Respect and honortheexpressed wishes ofrecipients of service.

B. Fullydisclose thebenefits, risks, and potential outcomes of anyintervention; the personnel who will be providingthe intervention;and anyreasonablealternatives to the proposed intervention.

  1. Obtain consent after disclosingappropriate information and answering anyquestions posedbythe recipient ofserviceorresearch participant to ensurevoluntariness.
  1. Establish a collaborativerelationship with recipients of serviceand relevantstakeholders, to promoteshared decisionmaking.
  1. Respect the client’s rightto refuseoccupational therapyservices temporarilyor

permanently, even whenthat refusal has potential to resultin poor outcomes.

F. Refrain from threatening,coercing, or deceiving clients to promote compliancewith occupational therapyrecommendations.

  1. Respect a research participant’s right to withdrawfrom a research studywithoutpenalty.
  1. Maintain the confidentialityof allverbal, written,electronic,augmentative,and nonverbal communications, in compliancewith applicable laws, including allaspects of privacylawsand exceptions thereto (e.g.,HealthInsurancePortabilityand AccountabilityAct, FamilyEducational Rights and PrivacyAct).

I.           Displayresponsible conduct and discretion when engagingin social networking, includingbut notlimited to refrainingfrom postingprotected health information.

J.           Facilitate comprehensionand address barriers to communication (e.g.,aphasia; differences in language, literacy, culture) with therecipient of service(orresponsible party), student, or research participant.

Justice

Principle 4. Occupational therapy personnel shall promotefairness andobjectivity inthe provisionofoccupational therapy services.

ThePrincipleof Justice relates to the fair,equitable, and appropriate treatment of persons (Beauchamp &Childress;, 2013). Occupational therapypersonnel should relate in a respectful, fair, and impartial manner to individuals and groups with whom theyinteract. Theyshould also respect theapplicable laws and standardsrelatedto their areaof practice. Justice requires the impartial consideration and consistent followingof rules togenerate unbiased decisions and promote fairness.As occupational therapypersonnel, wework to uphold asocietyin whichall individuals have an equitable opportunityto achieveoccupational engagement as an essential component oftheirlife.

Related Standards ofConduct

Occupationaltherapy personnel shall

  1. Respond to requestsforoccupational therapyservices (e.g.,a referral) in atimelymanner as determined bylaw, regulation, or policy.

B. Assist thosein need of occupational therapyservices to secureaccess through available means.

  1. Address barriers in access to occupational therapyservices byofferingor referring clients to financial aid, charitycare, or pro bono serviceswithin the parameters oforganizational policies.
  1. Advocate for changes tosystems and policies thatarediscriminatoryor unfairlylimit or prevent access to occupational therapyservices.
  1. Maintain awareness ofcurrent laws and AOTA policies and Official Documents that applyto theprofession ofoccupational therapy.

F. Inform employers,employees, colleagues, students, and researchers ofapplicable policies, laws, and Official Documents.

  1. Hold requisite credentials forthe occupational therapyservices theyprovidein academic, research, physical, or virtual work settings.
  1. Provide appropriate supervision in accordancewith AOTA Official Documents and relevant laws,regulations, policies, procedures, standards, andguidelines.

I.           Obtain all necessaryapprovals prior to initiatingresearchactivities.

J.           Refrain fromaccepting gifts that would undulyinfluencethe therapeuticrelationship or havethe potential to blurprofessional boundaries,and adhereto employerpolicies when offeredgifts.

  1. Report to appropriateauthorities anyacts in practice, education, and research that are unethical or illegal.

L. Collaborate with employers to formulate policiesand procedures in compliancewith legal, regulatory,and ethical standards andwork to resolve anyconflicts or inconsistencies.

  1. Bill and collect fees legallyand justlyinamannerthat is fair, reasonable, and commensurate with services delivered.
  1. Ensure compliancewith relevant lawsand promotetransparencywhen participatingin a business arrangement asowner, stockholder, partner, or employee.
  1. Ensurethat documentationfor reimbursement purposes is donein accordancewith applicable laws,guidelines, and regulations.

P. Refrain from participatingin anyaction resultingin unauthorized access to educational content or exams (includingbut notlimited to sharingtest questions, unauthorized use of or accessto content orcodes, or selling access or authorization codes).

Veracity

Principle 5. Occupational therapy personnel shall provide comprehensive, accurate, and objectiveinformationwhenrepresenting theprofession.

Veracityis based on thevirtues of truthfulness, candor, and honesty. ThePrincipleof Veracityrefers tocomprehensive, accurate, and objectivetransmission ofinformation and includes fosteringunderstandingof such information (Beauchamp &Childress;, 2013). Veracity is based on respect owedto others, includingbut not limited to recipients of service,colleagues, students, researchers, andresearch participants.

Incommunicating with others, occupational therapypersonnel implicitlypromise to be truthful and not deceptive. When enteringinto atherapeuticor research relationship, the recipient of serviceor research participant hasa right to accurateinformation.Inaddition, transmission ofinformation is incomplete without also ensuringthat the recipient or participant understands theinformation provided.

Concepts of veracitymustbe carefullybalanced with otherpotentiallycompetingethical principles, cultural beliefs, andorganizational policies. Veracityultimatelyis valued as a means to establish trust and strengthen professional relationships. Therefore, adherenceto thePrinciple ofVeracityalso requiresthoughtful analysisof how fulldisclosureof information mayaffect outcomes.

Related Standards ofConduct

Occupational therapy personnel shall

  1. Represent credentials, qualifications, education, experience, training, roles,duties, competence, contributions, and findingsaccuratelyin all forms of communication.

B. Refrain from usingor participatingin theuse ofanyform of communication that contains false, fraudulent, deceptive, misleading, or unfairstatements or claims.

Record and report in an accurate and timelymanner and in accordancewith applicable regulations allinformation related to professionalor academicdocumentation and activities.

  1. Identifyand fullydiscloseto all appropriatepersons errors oradverse events that compromisethe safetyofservicerecipients.
  1. Ensurethat allmarketing and advertisingaretruthful, accurate,and carefullypresented to avoid misleadingrecipients of service,research participants, or thepublic.

F. Describethetype and duration ofoccupational therapyservicesaccuratelyin professional contracts, includingthe duties and responsibilities of allinvolved parties.

  1. Behonest,fair, accurate,respectful,and timelyingatheringand reportingfact-based information regarding employeejob performance and student performance.
  1. Give creditandrecognition when usingtheideasand work of others in written, oral, or electronicmedia (i.e., donot plagiarize).

I.           Providestudents with access to accurate information regardingeducationalrequirements and academicpolicies and procedures relativeto theoccupational therapyprogram or educational institution.

J.           Maintain privacyand truthfulness when utilizingtelecommunication in deliveryof occupational therapyservices.

Fidelity

Principle 6. Occupational therapy personnel shalltreat clients,colleagues, andother professionalswithrespect, fairness, discretion, andintegrity.

ThePrincipleof Fidelitycomes from theLatin rootfidelis, meaningloyal.Fidelityrefers to the dutyonehas to keepa commitment onceitis made(Veatch, Haddad,&English;, 2010).In the health professions, this commitment refers topromises madebetweenaproviderand a client orpatient based onan expectation of loyalty, stayingwith thepatient in atime ofneed,and

compliancewith acodeof ethics. Thesepromises can beimplied or explicit. Thedutyto disclose information that is potentiallymeaningful in makingdecisions is oneobligation ofthe moral contract between provider and client or patient (Veatch etal., 2010).

Whereas respectingFidelityrequires occupationaltherapypersonnel to meet the client’s reasonable expectations, the Principle also addresses maintainingrespectful collegial and organizational relationships (Purtilo &Doherty;, 2011). Professional relationships aregreatly influenced bythecomplexityof the environment in which occupational therapypersonnel work. Practitioners, educators,and researchers alikemust consistentlybalancetheir duties to service recipients, students, research participants, and other professionals aswellasto organizations that mayinfluencedecisionmakingand professionalpractice.

Related Standards ofConduct

Occupational therapy personnel shall

  1. Preserve,respect, and safeguard private information about employees, colleagues, and students unless otherwisemandated orpermitted byrelevant laws.

B. Address incompetent, disruptive, unethical, illegal, or impaired practicethat jeopardizes the safetyorwell-beingof others and team effectiveness.

  1. Avoid conflicts of interest or conflicts of commitment in employment, volunteer roles, or research.
  1. Avoid usingone’s position (employeeor volunteer)or knowledgegainedfrom that position in such amanner as togive rise to real orperceived conflict of interest among the person, the employer,otherAOTA members,orotherorganizations.
  1. Bediligent stewards ofhuman, financial, and material resources of their employers,and refrain from exploitingthese resourcesforpersonal gain.

F. Refrain from verbal, physical, emotional, or sexual harassment of peers orcolleagues. G. Refrain fromcommunication that is derogatory, intimidating, ordisrespectful and that

undulydiscourages others from participatingin professional dialogue.

  1. Promote collaborativeactions and communication as a memberof interprofessional teams to facilitate qualitycare and safetyforclients.

I.           Respect thepractices,competencies, roles,and responsibilities oftheirown and other professions to promoteacollaborative environment reflectiveof interprofessional teams.

J.           Use conflict resolution and internal and alternativedispute resolution resources as needed to resolve organizationaland interpersonal conflicts, as wellas perceived institutional ethics violations.

  1. Abidebypolicies, procedures, andprotocols when servingor actingon behalf ofa professional organization or employer to fullyandaccuratelyrepresent theorganization’s official andauthorized positions.

L. Refrain fromactions thatreducethepublic’s trustin occupational therapy.

  1. Self-identifywhen personal, cultural, or religiousvalues preclude, orare anticipated to negativelyaffect, theprofessional relationship orprovision ofservices, while adheringto organizational policies when requestinganexemption from serviceto an individual or groupon thebasisof conflict of conscience.

References

American Occupational TherapyAssociation. (2014a).Enforcement procedures forthe Occupationaltherapy codeof ethics and ethics standards. American Journal ofOccupational Therapy, 68(Suppl. 3),S3–S15. http://dx.doi.org/10.5014/ajot.2014.686S02

American Occupational TherapyAssociation. (2014b). Occupational therapypractice framework: Domain andprocess (3rd ed.).American Journal of Occupational Therapy,68 (Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006

Beauchamp, T.L.,&Childress;, J. F. (2013).Principles of biomedical ethics(7th ed.).New

York: Oxford UniversityPress.

Braveman,B., & Bass-Haugen, J. D. (2009).Social justice and health disparities:An evolving discoursein occupational therapyresearch and intervention. AmericanJournal of Occupational Therapy, 63, 7–12. http://dx.doi.org/10.5014/ajot.63.1.7

Purtilo, R., &Doherty;, R. (2011).Ethical dimensions in the health professions(5th ed.).

Philadelphia: Saunders/Elsevier.

Veatch, R. M., Haddad,A. M., &English;, D. C.(2010).Case studies in biomedical ethics. New

York: Oxford UniversityPress

Ethics Commission(EC)

YvetteHachtel, JD, OTR/L, EC Chair (2013–2014)

LeaCheyneyBrandt, OTD, MA, OTR/L, EC Chair (2014–2015) Ann MoodeyAshe, MHS, OTR/L(2011–2014)

JoanneEstes, PhD, OTR/L(2012–2015)

LorettaJean Foster, MS,COTA/L(2011–2014) WayneL. Winistorfer, MPA, OTR (2014–2017) Linda Scheirton, PhD, RDH (2012–2015)

Kate Payne, JD, RN (2013–2014)

Margaret R. Moon, MD, MPH, FAAP(2014–2016)

KimberlyS. Erler, MS, OTR/L(2014–2017) Kathleen McCracken, MHA, COTA/L(2014–2017)

DeborahYarett Slater, MS, OT/L, FAOTA, AOTA Ethics ProgramManager

Adopted bythe RepresentativeAssembly2015AprilC3

  1. This document replaces the 2010 documentOccupational TherapyCodeof Ethics and Ethics Standards (2010),previouslypublished andcopyrighted in 2010 bytheAmerican Occupational TherapyAssociation in the American Journal of Occupational Therapy,64,S17– S26. http://dx.doi.org/10.5014/ajot.2010.64S17

Copyright © 2015 bytheAmerican Occupational TherapyAssociation.

Citation.American Occupational TherapyAssociation. (in press). Occupational therapycodeof ethics (2015). AmericanJournal of Occupational Therapy,69(Suppl.3).

References

Ethics: Occupational Therapy Code of Ethics and Ethics Standars (2015) pdf

Ethics: Enforcement Procedures for the OT Code of Ethics and Ethics Standards-pdf

Ethics: Occupational Therapy Code of Ethics and Ethics Standards (2010) - pdf, 81 kb - See more at: http://www.aota.org/About-Occupational-Therapy/Ethics.aspx#sthash.EebZmkf8.dpuf