Ari Ginsberg. PT, DPT, MSIOP
What are ethics? Almost every definition of ethics includes the term morality. Morality explores the idea of what is considered right and wrong. For example, is it wrong to steal, or is it right to give charity to the poor? Although the answer to these questions seems obvious to most, it gets more complicated and unclear when new variables are added to the equation. For instance, is it wrong to steal from the rich to feed the poor? Or should you give charity to people who you feel are lazy and not looking for work? Also, what percentage of your wealth should you give to charity? There is much more complexity and ambiguity to morality in these situations. How do most people answer these questions? (Subjectivity of Ethics)
Subjectivity in Ethics
Due to this moral ambiguity, a lot of subjectivity exists in ethics and morality amongst different cultures and religions.
One example from the book The Righteous Mind: Why Good People Are Divide by Politics and Religion by Jonathan Haidt, is that in India it is unethical to call your parent by their first name, but in America that is not the case.Jonathan Haidt
One reason for general ethical subjectivity is that ethical systems cannot anticipate all the possible scenarios that may arise. Additionally, as societies advance, new situations are created that could not have been accounted for by ethical systems from the past. It is therefore critical that we acknowledge a certain level of subjectivity and broaden our horizons and tolerance for others.
2 Reasons Why Moral Ambiguity Exists
- Ethical systems cannot anticipate all scenarios
- Ethical systems need to evolve with society
Ethics for Physical and Occupational Therapists
Just as ethics and morality are necessary in society, a specific branch of ethics relates exclusively to healthcare clinicians, medical ethics. It helps guide ethical decision making amongst medical professionals. Most professional organizations develop ethical systems for clinicians. Specifically, physical and occupational therapy professional organizations have created guidelines for ethics in physical and occupational therapy. They are called the APTA and AOTA Code of Ethics and they provide principles to assist clinicians when ethical scenarios arise.
The APTA and AOTA Core Values
Both Codes of Ethics are premised on core foundational values. The APTA core values include accountability, altruism, collaboration, compassion and caring, duty, excellence, and integrity. The AOTA core values are altruism, equality, freedom, justice, truth, and prudence. Every ethical principle can be traced back to its origin, the APTA and AOTA core values. These values are broad and provided leeway for the APTA and AOTA to fashion ethical principles.
The Evolution of the AOTA Code of Ethics
As mentioned earlier, as society evolves there is often a need to revise and update ethical codes. The AOTA recognized that occupational therapy has changed since its inception of the AOTA and has updated their Code of Ethics in 2020. One example of occupational therapy evolution would be the use of technology and the ethical implications involved. A good example of this would be telehealth. The Covid-19 pandemic created new opportunities for healthcare delivery as in-person visits were somewhat dangerous. Telehealth was a response to the pandemic and has been adopted by the APTA and AOTA as valid for the delivery of physical and occupational therapy services.
A New Ethical Dilemma
An ethical dilemma that has recently emerged for occupational therapists is how to work on dressing skills with clients using telehealth. Is it inappropriate due to the rampant nature of computer hacking, or should it be acceptable if the clinician is using a reasonably secure connection? Another question would be, in what situations should a clinician recommend telehealth? Let’s say the patient would benefit to a greater degree with in-person visits, is it unethical to recommend telehealth? These are some of the numerous questions that have emerged as a result of professional evolution in physical and occupational therapy.
Using Subjectivity in Ethics for Physical and Occupational Therapists
Even though the principles of the APTA and AOTA Codes of Ethics are meant to guide our decisions, there is often a lack of clarity. One of the reasons is based on what was mentioned above, it is impossible for an ethical system to consider every scenario. Also, the reading of these Codes of Ethics is subject to a fundamental debate. Are we supposed to read the principles and analyze them based on the literal wording, or the conceptual underpinnings of the principle?
A Classic Philosophical Debate
The same philosophical debate exists in every religion’s bible as well as the interpretation of the Constitution of the United States of America. How literal do we take the Constitution versus trying to understand the purpose of the amendments? There is no right or wrong answer to this question, it depends on your intuition. So too with ethics for physical and occupational therapists. How literal or non-literal you want to read the APTA Code of Ethics is up to your intuition.
The Benefits of Ethical Understanding
We as clinicians need should recognize this reality and try not to be judgmental in situations that rely on our intuition. Perhaps the other clinician had a different intuition from you, and that is why they made the decision to behave in the way that they did. For more info on this topic, check out Let’s Get Ethical: Ethical Boundaries for PTs/OTs, a 2.5-hour PT/OT CEU course that is designed to explain how we as clinicians rely on our intuition in an ethically ambiguous situation. You can also fulfill your physical therapy ethics requirement in NJ as well as your ethics CEU requirement in many other states. I look forward to hearing from you!