After reading over the Peloquin article, the AOTA Code of Ethics, the NBCOT Code of Professional Conduct, and examining your own values, consider ONE of the following ethical dilemmas and how you might go about making a decision that is congruent with your personal and professional ethical code.  Fill out the accompanying outline to explain what your recommendation is and how you came to that decision. Remember that an ethical dilemma is worthy of discussion because two or more ethical principles are in tension with each other and the “correct” choice isn’t obvious. 

Scenario A Bob was a 62-year-old Vietnam War veteran who had had multiple CVAs and a history of hypertension and diabetes. After his CVAs, he spent a few years in several nursing homes receiving rehabilitation therapies. He was then referred to a day rehabilitation program for 6 weeks of intensive outpatient therapy. After discharge from day rehabilitation, he was referred to the outpatient clinic for continued occupational and physical therapy. Bob lived alone in an accessible apartment and had an aide who assisted him in all his activities of daily living (ADLs) and home management tasks. Bob’s stated goal for occupational therapy was to “do more for himself.” Over the course of several months of occupational therapy, it became apparent that Bob was not using the skills he attained in therapy in his home environment. He was continuing to rely on his aide for dressing, bathing, toileting, and cooking, even though he required only setup or minimal assistance with these tasks. When confronted with the discrepancy between his abilities and his actual performance, Bob admitted that he enjoyed having the aide do these things for him and did not want to do them himself at this time. The occupational therapist reviewed Bob’s goals and progress with him and stated her intention to discharge him from occupational therapy. Bob became irate, stating that he had multiple funding sources, including Medicare, Medicaid, and the Veterans Administration, and that if he wanted to have therapy, then he could have it as long as he wanted.

(from: AOTA (n.d.) The American Occupational Therapy Association advisory opinion for the Ethics Commission: Social justice and meeting the needs of clients)

Scenario B Ashley was a 12-year-old girl who had cerebral palsy that had resulted in left hemiplegia. She had been receiving occupational therapy three times a week since a routine screening at age 2 identified her as eligible for related services because of an orthopedic impairment. Ashley was in a regular classroom and was currently on the honor roll. Her occupational therapist determined that direct services were no longer necessary and placed her on consult status for occupational therapy. Ashley’s mother was fighting this change because she believed that her child still needed occupational therapy to “fix her left arm.” The occupational therapy report stated, “Ashley has met her goals and gained maximum benefit from occupational therapy in the school environment. Ashley no longer requires the direct support of occupational therapy to benefit from her current educational placement.”

(from: AOTA (n.d.) The American Occupational Therapy Association advisory opinion for the Ethics Commission: Social justice and meeting the needs of clients)

Scenario C Lou is an 85-year-old man with a diagnosis of Parkinson’s Disease, which has impacted his ability to safely and independently perform his ADLs and IADLs. He lives alone in a two-story home where he and his wife had lived for the past 50 years. Since his wife passed away 2 years ago, his physical and emotional health have declined. Lately, he has been falling inside his home and his 3 adult children are afraid that he is going to wind up with a fracture, head injury or worse. His neurologist recommended that he see an outpatient OT for balance and fall prevention, but when he is in the program, it is clear that he is not going to be able to restore his balance function. His children want him to move into a more supportive environment, but he adamantly opposes that. He refuses to have anyone help him at home. His children want the OT to document that Lou is not cognitively competent so that they can make the decision to move him out of his house into a safer environment.



What are the possible choices for action in this situation?

What AOTA Core values, AOTA Ethical principles and/or NBCOT Standards of conduct are to be considered here? Explain your reasoning.

What is your recommendation? What should be done in this situation? Why?

How do your personal values inform your decision?

Grading Rubric:

Shows an understanding of the AOTA Code of Ethics and NBCOT Standards of Conduct (uses terminology correctly, chooses appropriate principles)- 5 points

Recommendation is appropriate and is well justified – 3 points

Incorporates personal values appropriately – 2 points

TOTAL – (up to 10 points)

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