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Ethical Reasoning

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ashley chacon-baker

on 20 February 2013

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Transcript of Ethical Reasoning

Don't forget to register for
Conference! 1. Understand the ethical concepts, terms, and research that assist in the process of ethical reasoning

2. Use theory as a basis for understanding and analyzing ethical scenarios

3. Utilize a framework for applying principles of ethical reasoning to clinical scenarios

4. Integrate philosophical foundations with current research to critically think and problem solve Objectives Ethical
Reasoning Wednesday, February 20, 2013 History and Context of Ethical Reasoning Philosophical Ethical Reasoning Focus on Consequences

David Hume, Jeremy Bentham, John Stuart Mill

The “right action” is determined by the results or consequences rather than by the intrinsic features

The ends justify the means
The greatest good for the greatest number
Good/Evil is balanced through decision making Focus on Action

Immanuel Kant

The “right action” is based on the duties of the individuals to one another

Consider the responsibility to particular duties and rights

Conscious guides decision making

Emphasizes the act or means rather than the result MORAL DEVELOPMENT THEORIES Moral Development
One of the first to theorize and write about morality and moral education

The moral being is the product of a dynamic interrelationship between a person and the social setting.
Cognitive Position; morality is linked to reason and intelligence.
Education aims to provide conditions where intellectual and moral development can occur.
Moral stages are part of the developmental process. JEAN PIAGET
Implied that moral reasoning is developed in hierarchical stages.

Piaget's view of morality stemmed from his theory of socialization.
Respect for people rather than tradition or rules

Two moralities
Morality of Constraint
Morality of Cooperation
Inability to distinguish between reality and imagination

Use of logical thought with regard to concrete objects (age 7)

Use of logic to formulate inferences about abstract ideas (early adolescence) Series of stages of cognitive growth: 3 Stages of Moral Development in Children:


Autonomous Stages in
cognitive development
the stages of

Moral judgment is developmental

Moral judgment is mainly controlled by cognitive processes

Moral judgment has a role in decision making in real-life situations Kohlberg's Stage
Theory 4 Component Model of Moral Behavior Feminist View of Moral Reasoning KOHLBERG

Focuses on cognition and the sequential stages of moral reasoning.

Says that people use 6 problem-solving strategies in a developmental sequence.

Emphasized the social nature of morality as well as the stages of moral development.

He identified 3 levels of moral development, each having 2 stages:

Moral development may stop at any stage, varying from person to person and is not a function of age. JAMES REST

Based on Kohlberg - done with extended research past Kohlberg
“more to ethical behavior than the moral judgment emphasized by Kohlberg”

Sees Kohlberg’s 6 steps differently
More about cooperation in people that leads to right/wrong judgment

The 4 components describe psychological aspects of a person that help them to make moral decisions

Component 1: Moral Sensitivity
How a person looks at a situation and thinks about how the possible actions that will be taken in the situation can affect other people.

Component 2: Moral Judgment
Deciding if the actions are right or wrong.
Whether they are morally right or wrong is impacted by social cooperation and fairness.

Component 3: Moral Motivation
A person compares moral values versus other personal values-these should be prioritized
If a person prioritizes moral values over others then they will be motivated to make the morally right decision in a situation

Component 4: Moral Character
To complete a moral action the person must have the “perseverance, ego strength, and skills” to do so or the action may never come to fruition Two views of men and women within moral reasoning- “research based on extensive interviews with women”

Men: rules and justice: men pick rules over relationship with other people

Women: Caring and relationships: women pick relationship over moral rules

3 Stages of morality
orientation to individual survival- own interest
goodness of self-sacrifice- interest of others
responsibility for consequence of choice- feel the need to take care of others

There is a chance that justice and caring can blend so that men and women both have potential to look from both points of view of morality Developed after Kohlberg - his research assistant BASIC MORAL PRINCIPLES and THEORIES OF ETHICAL REASONING 8 Major Ethical Principles
in Health Care Include: i. autonomy
ii. beneficence
iii. non-maleficence
iv. justice
v. veracity
vi. fidelity
vii. privacy
viii. confidentiality AUTONOMY “the right of an individual to be self-determining and make independent decisions about his or her life”

(Hanson, 2003) BENEFICENCE & NONMALEFICENCE Beneficence- actions that benefit others; actively doing good and considering the potential harm of actions (Kanny & Slater, 2008)
Nonmaleficence- “do no harm” (Purtilo, 2005); avoid doing harm or creating a situation in which harm could occur (Kanny & Slater, 2008) JUSTICE Justice- issues of fairness, human rights, equality, and fair opportunities

Distributive justice- fairness in allocating healthcare resources

Procedural justice- process for ordering things in a fair way

Compensatory justice- provision of resources to an individual who is wronged or injured

(Purtilo, 2005) MORAL PRINCIPLES RELATED TO RELATIONSHIPS Veracity- obligation to tell the truth

Fidelity- keeping promises and contracts; meeting patient’s reasonable expectations

Confidentiality- keeping client information within appropriate limits and abiding by rules of consent

Privacy- aspects of a person’s life that are not to be intruded upon or shared outside the healthcare setting

(Purtilo, 2005) FRAMEWORKS FOR ETHICAL DECISION MAKING Occupational therapists face ethical dilemmas or ethical stress and need a framework to guide the actions taken related to this issue. TWO FRAMEWORKS: Purtilo's "Six Step Process" (2005)

1. Gather relevant information
2. Identify the type of ethical problem
3. Use ethics theories or approaches to
analyze the problem or problems
4. Explore the practical alternatives
5. Complete the action
6. Evaluation the process and outcome Morris (2003)

1. Identification of the ethical dilemma
2. Analysis
3. Evaluation
4. Consensus for action When utilizing the frameworks for ethical decision making one must: Use knowledge of basic ethical principles and ethics theories

Utilize AOTA’s Occupational Therapy Code of Ethics

Possess courage and determination when carrying out the action chosen

Have a consensus among individuals involved (emphasis in Morris model) Guide for Ethical Decision Making
(Box 8-3, page 198) ETHICAL REASONING IN PRACTICE Ethical
Reasoning in Practice Popular ethic debates
Cloning, stem cell research, end of life issues

Occupational therapy ethics
Becoming more frequent and evident in workplace
Ethical dilemmas most often revolve around common ‘day to day’ things Resources on Ethics Seeking assistance during ethical dilemma is extremely important
ensures that you fully understand situation
the range of options and potential consequences
addressed appropriately
Resources include:
Ethics committees
Support and discussion TAKING
ACTION extremely important but may have consequences or repercussions

witness harm or an intervention that does not benefit the patient to tell or not to tell?
in some cases, laws regarding mandatory reporting of abuse may apply
in some cases, there are statutory protections
however, whistle blowing may be done for self-serving reasons Conflicting
Priorities Therapists try to meet the directives of the organization, the needs of the patients, and their own professional ethics and values
get caught in “ethical no-man’s land”

IRF needs 75% of patients to fall into one of 13 diagnostic categories
admits patients from acute care referral hospital who are already independent in order to keep beds full and maintain status as an IRF Ethical? Legal? or Both? Laws tell us what we shouldn't do
Ethics give us the standards to live by

“can” do something does not mean it “should” be done
actions may be legal, but may not be ethical (according to laws, some decisions may be right but from an ethical standpoint they may not meet the clients interests or needs)

For example:
Legal- In many states OT practitioners may use PAMS as part of their legal scope of practice
Ethical- PAMS are not generally part of OT curricula, so those who use them should obtain continuing education in order to be competent according to the ethical principle of duty STUDIES IN APPLICATION TO ETHICAL REASONING No research found to date specifically discusses how OT’s apply ethical reasoning effectively to actual practice dilemmas.

Research on the following professions can be used to make suggestions for future research within occupational therapy
Teaching, Nursing, Counseling, Accounting, Medicine, Veterinary Medicine, Journalism, Dentistry Ethical Reasoning & Education Hypothesis: Gains in ethical reasoning are most affected by formal education
Thus, Individuals who demonstrate higher levels of moral reasoning abilities may be more able to think critically or problem solve to see what might be best for individuals and society as a whole

(Rest & Narvaez, 1988, 1994) Ethical Reasoning & Physical Therapy Utilitarian vs. ethical principles
Consulting with colleagues or the PT Code of Ethics
Influence of morals and values from a young age
Ethical reasoning must be modeled OT vs. PT Analyze transcripts of interviews involving ethical dilemmas
Physical Therapists
Diagnostic or procedural style
Occupational Therapists
Narrative style

Affected by context of the dilemma, where it occurred, the work group, the patient group, and the hierarchical relationship with the organization. Ethical Reasoning and OT Further research is needed

James Rest’s Four-Component Model

Thinking and processing (sensitivity, judgment)
Motivation and ability to take action
Learning experiences that lead to moral action Thank you! Sincerely,

Ashley Chacon-Baker, Lindsay Chavis, Kohl DeStefanis,
Rachel Durante, Alyssa Eich, Kathleen Ellen, Gina Gasparrini, Lindsey Raffol, & Elaine Severo Beauchamp, T.L. & Childress, J.F. (1989). Principles of biomedical ethics. New York: Oxford University Press.

Consortium of Women’s Colleges. (2013). Kohlberg’s Stages of Moral Development. Retrieved from http://cwcpyschology.wikispaces.com/m1t07

Hansen, R.A. (2003). Ethics in occupational therapy. In E. B. Crepeau, E. C. Cohn & B. A. Boyt Schell (Eds.), Willard and Spackman’s occupational
therapy (10th ed., pp. 953-961). Philadelphia, PA: J. B. Lippincott.

Kanny, E. M., & Slater, D. Y. (2008). Ethical reasoning. In B. A. Boyt Schell & J. W. Schell (Eds.), Clinical and professional reasoning in occupational
therapy (pp.188-208). Philadelpha, PA: Lippincott Williams & Wilkins.

Morris, J. F. (2003). Is it possible to be ethical? In J. B. Scott (Ed.), Reference guide to the occupational therapy code of ethics. Bethesda, MD:
AOTA Press.

Purtilo, R. B. (2005). Ethical dimensions in the health professions (4th ed.). Philadelphia, PA: Elsevier References Case Study Can We Date?

Megan is a fieldwork II student at a psychiatric outpatient clinic in a small town. She is an excellent student and is working independently as a therapy group leader by the second month in the placement. She and her occupational therapy supervisor get along quite well and she is comfortable in being open about her feelings with her supervisor

Matthew, a 25-year-old weather announcer from a local television station is admitted for acute situational depression related to several crises in his life. In the last 6 months, both his grandfather and mother died, his grandfather of a long-term illness, and his mother from acute leukemia. He has been experiencing increased stress on the job and feels overwhelmed at work. Matthew was placed in the therapy group in which Megan is co-leader with the psychologist.

After about 2 weeks, Megan confided to the supervising occupational therapist that she was very attracted to Matthew and that he has been flirting with her. They discussed the importance of upholding a professional client-therapist relationship and nothing more was said. During the next 2 weeks, Matthew continues to progress well in therapy and was scheduled to be discharged in a week. At this time, Megan decides to go out with him to a local movie, at which the supervising OT sees her. Megan has 3 more weeks remaining on her fieldwork placement. Chapter 8 Schell & Schell 1. Go to m.socrative.com
2. Type in 121390, and click "Join Room"
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