ch 7-9 Flashcards
Core Concepts of Ethical Practice
Foundation for professional conduct and service provision.
Ethical challenges arise from:
Patient care complexities.
Interprofessional relationships
Ethical Tensions
Autonomy:
Beneficence
Conflict:
Questionable patient cognitive capacity to understand health information.
Decisions that may counter professional recommendations but are patient-appropriate
Importance of Competency and Capacity
Competency: Legal assessment by a judge.
Capacity: Ability to make informed decisions.
Challenges:
Dynamic and fluctuating nature of competency
Principles of the AOTA Code of Ethics
Understanding Ethical Principles
Ethical dilemmas: Conflict between two or more actions; only one can be chosen
Ethical issues arise across all settings, populations, and lifespans
Role in Clinical Practice
Guide recommendations for safety in daily activities.
Address risks associated with impaired cognition
Ethical Decision-Making Framework
Purpose
-Systematic reasoning to resolve ethical dilemmas.
Ensures decisions are:
Best suited to the situation.
Defensible even when imperfect.
Framework Features
-Supports clinical reasoning and professional practice.
- Common elements across multiple ethical models.
Analysis of Ethical Dilemmas
Complexity of Ethical Issues
Require thoughtful, comprehensive approaches
Deliberative Process
Develop options to resolve the issue.
Evaluate options based on:
Benefits to the patient.
Prevention of harm.
Respect for autonomy.
Legal and regulatory considerations
Competence vs. Capacity
Competence:
-Legal assessment by a judge in court.
Capacity:
-Clinical determination of functional abilities.
-Dynamic and context-dependent
Role of Surrogates
Act on behalf of individuals lacking capacity.
Struggle with balancing:
Respect for autonomy.
Emotional and financial influences.
Capacity Assessments
Combine clinical judgment and standardized tools
Assess four components:
Understanding
Appreciation
Reasoning
Expression of choice
Practitioner Responsibilities
Ensure assessments are within scope of practice.
Utilize ethics codes and decision-making frameworks.
Engage surrogates and include patients when feasible
Decision-Making Capacity in
Parkinson’s Disease
Individuals with Parkinson’s disease show reduced performance on all four capacity components
Implication
Progressive disease requires repeated capacity assessments over time
Capacity in Acquired Brain Injuries
limited decision-making capacity due to executive dysfunction:
Difficulty using awareness of cognitive impairments to weigh decisions.
Evidence of awareness in conversations may not translate to real-world scenarios
Alzheimer’s Disease and Mild
Cognitive Impairments (MCI)
Clinical Implications
Capacity should be reassessed over time in longitudinal studies or long-term interventions
Dementia and Capacity Assessment
Progression Challenges
As dementia progresses, capacity declines across components.
Interfering factors include:
Lack of motivation.
Inattention or mistrust.
Misunderstanding expectations.
Assessment Validity
No single tool predicts when a surrogate decision maker is needed.
Agreement between tools and evaluators is highest for understanding and lowest for appreciation
Brain-Training Programs
Growing interest in programs promising cognitive improvement.
Issues to consider:
Self-published effectiveness data.
Limited evidence connecting games to improved everyday functioning
Privacy Concerns
Companies often partner with researchers without oversight.
Clients’ neuro-data may lack privacy protections
Clinical Considerations
Discuss privacy and cost-benefit concerns with clients before recommending products.
reimbursement and Ethics
Providing services without patient consent violates the AOTA Code of Ethics.
Ethical Risks -
Patients with cognitive impairments cannot consent or advocate for themselves.
Financial decisions about care are outside the patient’s control
Ethical Challenges in Health Care Systems
Business Pressures
Ethical Dilemmas
Advocacy and Reimbursement
Challenges for Practitioners
Advocate for needed patient services.
Identify alternative funding and access options
Ethical Discernment
Known in occupational therapy as professional judgment.
Foundational to ethical decision-making in evaluation
Purpose of Codes
Provide clear boundaries for professional behavior.
Protect the integrity of the profession and public trust
