Everyday Ethics: From the Classroom to the Clinic

Everyday Ethics

This is Part I of a two-part mini series on ethics in OT practice. This post discusses my experiences as a Level II fieldwork student and how ethical questions in the workplace aren’t always as cut and dry as ethical questions in the classroom. Click here to read Part II, about productivity standards and their impact on ethical practice.


Like any other OT/A student or practitioner, I’ve learned about the Occupational Therapy Code of Ethics, the kinds of activities or behaviors that are considered ethical violations, and how to avoid practicing unethically. In the classroom, we discussed the importance of documentation, patient privacy, HIPAA, and preventing ethics violations, and it seemed easy enough to understand. However, I’m finding that in the “real world,” things are not always quite as simple.

Since I’ve been working at the state VR office, I’ve been involved in several situations that I would consider “ethically iffy,” if not outright ethical violations. Although nobody means to do harm or is intentionally entering into these scenarios, there have been several incidents I have observed and learned from. This post includes just a sampling of the kinds of ethically challenging situations I’ve faced so far, and while all three have fairly obvious solutions, there have been other times when doing “the right thing” was nowhere near as clear.

Note: For my own learning and the benefit of readers, I’ve referenced the specific Principles from the OT Code of Ethics for each example below. Missouri College also has a great article that nicely summarizes the OT Code of Ethics.

Scenario 1: Big Mouth, Big Problems

OT Code of Ethics Principle 3 – Autonomy: Occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent.

A few weeks ago, I was sitting in on an appointment with my supervisor, a rehabilitation counseling student, and a VR client. In the middle of the meeting, another VR counselor came in and asked the student about several people, as she read the clients’ first and last names from a list. When it happened, I was shocked that an experienced counselor would so blatantly violate these clients’ privacy. The appropriate way to handle this would have been to pull the student aside to ask her or show her the list and have her indicate whether or not she had their files. By announcing the first and last names of these people in front of another client, this counselor clearly violated their rights to privacy (i.e. HIPAA) and set a very poor example for us students.

Scenario 2: File Follies

OT Code of Ethics Principle 3 – Autonomy: Occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent.

During one of my first initial interviews with a client, I made the mistake of leaving files with vulnerable and personally identifying information open on my desk. By some merciful act of God, the man I was seeing was formerly employed as a medical records clerk, and he politely asked if he could close the files and move them aside so that the client’s information was no longer visible. I was so embarrassed at my own stupidity, and I quickly removed the files and put them away! However, the incident was definitely a valuable learning experience, and I have been careful ever since then to make sure that no client names or information is visible when clients enter my office.

Scenario 3: Hungry for Trouble

OT Code of Ethics Principle 4 – Justice: Occupational therapy personnel shall promote fairness and objectivity in the provision of occupational therapy services. (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)

Last week I met with a client and his mother to continue helping him develop employment skills. “George” loves to cook, and he tells me about the meals he’s made for his friends and family every week. I enjoy hearing about George’s cooking skills, and it’s been a great way to build rapport with him and his mother.

As our appointment ended, George began discussing how excited he was to help prepare Thanksgiving dinner this year. At one point, he stated that I should try some of his food, and his mother agreed, saying that I should “stop by and get a plate.” Although George and his mother saw nothing wrong with inviting me over for dinner, I am clearly unable to accept the invitation (no matter how delicious dinner sounds!). They weren’t forceful about the invitation, and they may not even mention it again, but if they do I plan to simply let them know that while their case is active I cannot be involved in any activities with them outside the office.


These are just three situations in which I have been faced with challenges to the OT Code of Ethics. However, there have been other situations in which I have had to question my personal ethical beliefs as they align (or not) with the policies of this workplace and the profession.

For example, one of the most important policies here is to not provide clients with services prior to the development of their official VR Plan for Employment that listed the various services they will receive as VR clients. This is important because if clients start receiving services that are not listed on their Plan, there is no way to track the services being provided, justify charges, or give the VR counselors “credit” for the work they’ve done.

However, it’s been very difficult for me to wait for the Plans to be put in place before providing services because I feel like it’s unethical to keep these clients waiting for weeks at a time with no services when I could make use of my knowledge and skills to help prepare them for work. Although I am certainly not doing anything super intensive and I’ve gotten permission from my supervisor to provide resume development, mock interviewing, and other services before clients have Plans, it’s frustrating that doing basic things like this while clients are waiting to be put on a Plan is technically “against the rules.”

A very tough ethical dilemma presented itself last week, when a client desperately needed services that were not on his Plan. He recently started working at a meat processing facility and had been there for a few days without the appropriate clothing for the job because he was under the impression that the employee provided clothing, which they did not. The client helps process animal carcasses, which is very dirty, bloody, and grimy work. To perform the job, he needed things like rubber boots, waders, and a waterproof poncho to stay “clean” and dry while he worked, but because these things were not originally on his Plan for Employment, he was unable to obtain these items without:

  1. Making an appointment with his VR counselor
  2. Returning to the VR office to see the counselor, amend his Plan, and sign the Plan
  3. Waiting for the purchase amount to be approved, and then
  4. Waiting for an office assistant to meet him at the store and purchase the items with the company card before he could begin using them

While I’m sure the client’s VR counselor worked to expedite the process as much as possible, this man still had to wait several days before we could provide him with clothing necessary to keep the job, even if it was eventually provided at no cost to him. In all fairness, typically the VR counselors do a great job of understanding the requirements of the jobs their clients obtain and meet their various needs for clothing and materials well before they start work, so situations like this are not the norm. However, it was extremely hard for me to hear about this client’s needs and know that there was nothing we could do to help while he went to work day after day, being splashed and splattered with no protection at all, until he could get clothing on his Plan.

I’m doing my best to adhere to the ethical standards of the profession and my workplace every day, but I’m finding practice in “the real world” much more challenging than the cases I read about in class. After listening to this man’s situation, it was very difficult for me to view the situation objectively and be OK with having him go to work every day and get covered in blood and animal waste because of “the rules.” It made me wish that there was some kind of emergency protocol that the counselors could use in situations like his, but there is not and he simply had to deal with the wait, as hard as it was. In this particular case, I truly felt that doing the “ethical” thing was not really ethical at all.

Finally, a note for other students: you may see things during fieldwork that give you pause. Although it’s not always easy, I encourage you to speak up and start a dialogue with your supervisor(s) about whatever it is that makes you uneasy, whether it’s inappropriate billing practices, seeing multiple clients at the same time, or therapists discussing client cases where others can hear. It’s important that you hold yourself and your supervisor accountable for adhering to ethical practices, and by staying silent you are contributing to a workplace environment where ethics are optional, which is never a place you want to be.

How have you handled ethical issues in your fieldwork or workplace? Share in the comments!


RESOURCES

HIPAA Guidelines for Fieldwork: This is a list of client information that you can and cannot discuss and/or write about as a FW student.

NY State Education Department: A quick overview of what HIPAA and FERPA guidelines mean for OT practitioners (and students).

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3 thoughts on “Everyday Ethics: From the Classroom to the Clinic

  1. […] impact practice for OTs and other rehabilitation professionals both in and out of the workplace. Click here to read Part I, about my experiences with ethics as a FWII […]

  2. Symen James July 6, 2016 at 2:19 am Reply

    That is a very well written article. I have a school therapy job, and I can say that dealing with the parents can be a lot tougher than with the child. I know it is out of genuine concern, but some really do cross a few lines with the ease and comfort for other children.

    • lej1123 July 10, 2016 at 8:29 am Reply

      Thanks for commenting! It seems that ethical challenges exist no matter where you work, and in my peds OT experience, dealing with parents IS often harder than providing interventions for the kids!

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