The standards prescribed in a professional code of ethics may reflect legislation, but it is not law. Ethical reasoning helps individuals to determine the types of activity or actions that are right and wrong, both with the society that the profession serves and with colleagues. If a therapist were found to have acted against their professional code of ethics, it would not necessarily result in criminal or civil proceedings (Dimond 1997). However, this does not imply that a code of ethics can be broken without consequence. The professional standards that govern the practice of occupational therapy are a blend of ethics and law. If a code of ethics is broken or un-professional behaviour discovered, it might also represent a violation of the law which could be punishable by the justice system as well the regulating body of a profession such as The College of Occupational Therapists.
The recent high profile case of a patient with motor neurone disease provides a scenario in which an Occupational Therapist may be involved (Therapy Weekly 2002). In this case, a patient with a terminal illness had expressed their wish that, when the time came, she would be assisted to commit suicide without the facilitator facing prosecution. As a profession that exists to facilitate and enable its clients to achieve their choice of lifestyle, where does the duty of the therapist rest when a patient makes such a request of their Occupational Therapist?
In their review of assisted suicide and its implications for occupational therapy, Royeen and Crabtree (1999) identified that patients with a terminal illness may seek to end their life because of depression, social isolation, persistent pain and physical debilitation. These potentially treatable conditions alter the outlook of these patients making death seem more desirable than continuing to live. Working from an occupational therapy perspective can help to alleviate these conditions, giving the patient the support they may be looking for. This presents a situation that requires an Occupational Therapist to use both ethical and legal reasoning to determine how they can help people.
From an ethical approach, if a client made the decision to end their life the code of ethics clause 2.1.1 says that clients normally have a right to make decisions about their health and any choices and decisions should be respected even if they conflict with professional opinion (College of Occupational Therapists 2000). Difficulties may arise when considering the value of ‘autonomy’. According to clause 3.3 in providing services to clients Occupational Therapists should uphold and promote the autonomy of the individual. If the patient has decided to take certain action that the professional disagrees with and intervenes to prevent it, acting in the best interests of the patient could be seen as ignoring the autonomy of an individual, which may present an ethical dilemma for many (Sims 1996). If the patient tells the therapist their intentions in confidence, permission should be sought to reveal the possible suicide attempt to another health professional who may be able to help as directed by clause 2.3.1 of the code of ethics.
By applying legal reasoning to this situation, an Occupational Therapist who is concerned for the well-being of a patient can notify social services and action can be taken under the National Assistance Act 1948 or the Mental Health Act 1983.
It is not an offence to take your own life, but it is an offence under the Suicide Act 1961 to encourage or to help another person to commit suicide (Williams 1997). If an Occupational Therapist knowingly supplies a patient with a piece of equipment with the intention that they use it for ending their life the therapist could be prosecuted.
Acts of Parliament can have an effect on the working conditions of Occupational Therapists as well as directing their work. An example of such an act is the Public Interest Disclosure Bill 1998 (Dimond). This gives protection against discrimination to employees who reveal malpractice at work. In situations where they observe bad practice in a workplace, it is important that people feel safe that they can act to rectify the situation without a threat to their employment. The issue must first be raised with their employers, and if subsequently the situation is not improved to an acceptable standard the professional can take the matter further. The act offers protection by enabling the individual to obtain an injunction that prevents threats of dismissal or unfavourable working conditions.
As with many situations in practice, there is a need for sound ethical reasoning and knowledge of legislation. Malpractice and its prevention is of central concern to the code of ethics of any profession, and the Code of Ethic and Professional Conduct for Occupational Therapists (College of Occupational Therapists 2000) contains requirements both to prevent it occurring and also to report its occurrence. The Public Interest Disclosure Bill (1998) and the requirement of the code to report and prevent malpractice means that no Occupational Therapist should hesitate to report anything they have witnessed if they consider it detrimental to the service provided to the public.
Acts of Parliament and a Code of Ethics for a profession make an essential contribution to the knowledge which members of that profession use when making clinical decisions. It is important that Occupational Therapists are aware of changes that occur in the legal context that they practice, it can be modified by new Acts of Parliament and new decisions in courts.
References
Alsop, A. and Ryan, S. (1996) Making the most of fieldwork education – A practical approach. Cheltenham, Stanley Thornes Ltd.
College of Occupational Therapists (2000) Code of ethics and professional conduct for occupational therapists. London, College of Occupational Therapists.
Dimond, B. (1997) Legal aspects of occupational therapy. Oxford, Blackwell Science.
Kyler, P. (1998) Issues in ethics for Occupational Therapy. OT Practice, September 37- 40.
Royeen, M. and Crabtree, JL. (1999) Assisted suicide and its implications for occupational therapy. Occupational Therapy International 6: (1) 65-75.
Sims, J. (1996) Client confidentiality: ethical issues in occupational therapy. British Journal of Occupational Therapy 59: (2) 56-61
Therapy Weekly (2002) Suicide Review. Therapy Weekly 28:(10) 1.
Williams, D. (1997) Know your rights. London, Readers Digest.
Bibliography
Baggott, R. (1994) Health and health care in Britain. London. Macmillan
Barnitt, R. (1993) What gives you sleepless nights? Ethical practice in occupational therapy. British Journal of Occupational Therapy 56: (6) 207-212
Brockett, M. (1996) Ethics, moral reasoning and professional virtue in occupational education. Canadian Journal of Occupational Therapy 63: (3) 197-205
Foto, M. (1998) Change, commitment and ethics:where do we stand? American Journal of occupational Therapy 52: (2) 87-89
