⚖ Conflict of interest/Boundary/Power imbalance/Ethics ⚖ Flashcards
How to address conflict of interest?
Step 1: gather information
Step 2: If uncertain whether a conflict of interest exists, seek advice from knowledgeable individuals such as managers, peers, the College, or legal counsel.
Step 3: Review standards of practice
If avoiding a conflict of interest is not possible?
Step 1: Discuss the conflict of interest with the client before providing services.
Step 2: Advise the client of their right to decline services at any time and, if possible, suggest alternatives.
Step 3: Document in the client records the steps taken to address the conflict.
When suggesting assistive devices…
Step 1: OT aware of power imbalance
Step 2: carefully, objectively, present clients with options, and allow clients to choose
Step 3: Recommend only products that are appropriately indicated, and that do not involve any personal gain, relationship, or financial interest for the OT or someone close to them.
Step 4: Client need to feel confident that the recommendation for the best equipment for them, but not becoz other factors
Step 5: Document
(Describe the relationship with vendor)
This applies unless the occupational therapist can manage the conflict of interest by taking these steps:
a. Disclose the nature of the benefit or relationship to clients in advance
b. Discuss other options for products or services
c. Assure clients that services will not be adversely affected should they select an alternative supplier or product
d. Document the discussion in the client record
Avoid self-referrals or soliciting clients
(for example, referring clients from an employer’s practice to the occupational therapist’s private practice). This applies unless alternative options are not available or are not in clients’ best interests (for example, clients are at risk of not receiving the services).
In these cases, take these steps:
Disclose the self-referral to the occupational therapist’s employer, clients, and others involved in the referral or services
Give clients the option of seeking alternative services
Document the full disclosure in the client record
Requests for Private Practice Follow Up with Clients
機構政策
不會影響professional judgement嗎？e.g. early discharge
Will the client feel obliged or pressured to comply with health providers?
how would colleagues, managers, clients, or others perceive this arrangement?
Advertising: OTs are not allowed to directly pressure or solicit his business to clients
Transparent to every stakeholder
Advertising in Occupational Therapy Practice
As noted in the regulation, information in advertisements must:
資訊準確 be verifiable by the occupational therapist
用字容易明白
不可與其他治療作比較not contain any testimonial, comparative or superlative statements indicating the practice is superior to other practices, and
不可指明用哪一個牌子的產品not reference a specific brand of drug, device, or equipment
Direct Pressure Sales or Solicitation
不可 cold calls, robocalls or unsolicited mass mail campaigns.
may share information about their business, via letters, pamphlets or other platforms, with:
其他人幫你宣傳third party referral sources, who are not directly receiving the health care, such as institutions, insurance companies, or lawyers.
interested parties within the area of practice to increase awareness of the services offered
Unacceptable
unrealistic expectations about the effectiveness of the services
guarantee the success of the service(s) provided
Uses endorsements代言 or testimonials.
Uses superlative terms such as “state of the art”, “cutting edge”, etc. when referring to a particular service or product used
Power imbalance
OT in a position of trust and authority over the clients → client- therapist relationship is inherently unequal
Client:
- relies on the OT’s clinical judgment and experience to address health-related issues
- OT has the ability to influence the client’s access to other resources and services (e.g. product)
- are expected to share disclose personal information about themselves but OT are not expected to disclose + should not disclose
- some body parts being touched (some degree of intimacy and vulnerability)
- may feel judged when OT examines them and ask questions to better understand their status and needs
- vulnerability of a client: their health status, life stage, social context, ability to access supports and resources, in discomfort, not speaking same language
- people who are at risk of being highly dependent on the occupational therapist or the services they can help them access, and where services may be prolonged or are high risk and intensive
How to reduce power imbalance?
Step 1: Be aware of the power imbalance inherent
Step 2: Understand how power dynamics impact the service
Step 3: Avoid creating situations where dependencies develop between clients and the OT
by…
- understanding and validating these emotions to build trust and rapport
- create a supportive environment where the client’s opinions matter
- provide choices, letting the client choose what works best for them
- client is involved in decision-making and feels confident in the rehabilitation process
- OT offer guidance based on expertise, but the client’s preferences are respected
- Instead of telling them what to do, we work together
How to avoid boundary crossing?
Before service:
declining services to those with whom you already have a personal relationship and where boundaries may not be maintained
During service:
Step 1: communicate appropriate boundaries from the start of the therapeutic-relationship
Step 2: understand power imbalance and not taking advantage of the client for personal/professional gain (e.g. sell product)
Step 3: Prevent crossing boundaries
By…
x accept gift, social invitation, financial offer x → indicate developing personal relationship → client expect something in return
have an automated message on voicemail/email explaining my business hours and how to access help outside of business hours
have a separate work and personal phone
Step 4: be alert to the changing nature of the therapeutic relationship (limit to a professional relationship) → open conversation with colleagues
warning sign of crossing professional boundaries
e.g. feeling developed towards clients (E.g. desire to form intimate relationship/internalization of client grief)
e.g. inappropriate disclosure of the OT’s personal information or emotional concern to the client (e.g. non-professional contact (e.g. personal email, social media use..))
→ confuse the client
→ client may assume the OT wants to have more than a professional relationship
e.g. engage in care that provides special privileges/ increased attention as compared to other clients
e.g. receipt or exchange of gift
What should OT do if a boundary is crossed?
Step 1: recognise and manage any shift in client’s expectations of boundaries
Step 2: written resource that clearly explain what to do in crisis situation / report to supervisor
Step 3: document, address, and rectify boundary violation e.g. discontinue service / refer to another provider
How to prevent potential sexual abuse/work with sensitive client?
- always obtain consent before initiating any service esp. touching, unless in emergency
- respect privacy and dignity e.g. use curtain in assessment and intervention space, use draping and garment to minimize exposure, provide option of an observer for potentially sensitive situation
The RHPA requires occupational therapists to make a mandatory report when they have reasonable grounds, obtained while practicing the profession, to believe that another regulated health professional (of the same or a different College) has sexually abused a patient.
The mandatory report must be in writing to the alleged abuser’s College. It must be made within 30 days after the obligation to report arises. However, if the occupational therapist has reasonable grounds to believe that the alleged abuser will continue to abuse the patient or will abuse others, the occupational therapist must file the report immediately.
If the occupational therapist becomes aware of the possible sexual abuse through a patient’s disclosure, they must inform the patient that the occupational therapist is obliged to make a mandatory report. They must obtain the patient’s written consent to disclose the patient’s name to the College. (know the provider’s name → legally required to find out if they are regulated and to file a report)
If the patient does not consent to disclose their name, the occupational therapist will withhold it from the report; suggest that they contact the College’s Manager, Investigations & Resolutions, for additional information.
Domestic Abuse
Legal duty to report, even without consent:
虐待兒童、老人院長者 child abuse/ elder abuse in long term care home
sexual abuse of a client by a professional
investiagtion
傳票出庭作證
協助調查
domestic abuse at home → NO legal duty to report
If the client is capable, the OT must respect their right to make decisions about their own lives. The OT can provide support and information for community resources and crisis lines. An OT cannot take further action if the client does not consent
BUT… immediate risk of harm (e.g. OT arrives at the client’s residence and observes the abuse in progress) → call 911 without consent
Ethical considerations and responsibilities when working with vulnerable populations, such as children or individuals with cognitive impairments? (CEP)
Consent process:
Obtain informed consent. Determine patient’s capacities in understanding the information and consent according to regulations. SDM if needed.
Emotional Attachment:
Therapists may develop emotional attachments to their clients, particularly when working with vulnerable populations who may evoke feelings of empathy, compassion, or protectiveness. While empathy is an essential component of therapy, excessive emotional involvement can cloud judgment and compromise professional boundaries
Power Imbalance:
There may be a significant power imbalance between the therapist and the client, especially when working with children or individuals with cognitive impairments who may be more dependent on the therapist for care and support. This power differential can affect the dynamics of the therapeutic relationship and increase the risk of boundary issues.
example of conflict of interest + boundary
Situation:
- During Chinese New Year, the tradition of giving and receiving red packets as gifts and blessings
- Accepting these gifts lead to conflicts of interest and cross the professional boundaries because it indicate developing personal relationship
Action:
- refused the gift
- engage in open discussions with clients about the conflict of interest associated with accepting gifts
- explain the importance of upholding ethical standards
(- redirected residents and families to appropriate channels for providing feedback for care services)
(Don’t thank the client because it may confuse the client, like encouraging him, client expect something in return)
example of conflict of interest + boundary + screen referral
Situation:
- a potential client was identified as the son of my dad’s colleague
Action:
- recognized the potential conflict of interest due to the personal connection between our families
- cannot maintain professional boundaries
- report, disclose and seek advice to my supervisor
- provided information about the personal relationship and expressed my decision not to accept the referral
- see if there is another provider/team member who could take this referral
- reminded my supervisor not to disclose which OTis responsible for this client to maintain confidentiality and avoid potential conflicts of interest
(if discovered after starting the service)
- discuss my concern with the client, and have a shared understanding of a plan and next step
- document the understanding, steps I did to reduce a potential conflict of interest
