Occupational Therapy Ethics Essay

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Ethics in the nursing and occupational therapy communities is an ongoing concern that is being addressed in a number of different arenas and manners. This paper discusses national and international frameworks that have been created to address, define and provide ethical behavior guidelines for the healthcare communities that comprise measured and timely responses to the ethics issue as it pertains to those communities. Specifically, the paper will look at ethical decision making in healthcare regarding patient consent; how it is presented, used and documented. Additionally, the paper will seek legal and ethical frameworks as defined by a variety of Australian and international healthcare and medical entities.

National and International Ethical Frameworks

A number of organizations have established guidelines for ethical behavior by the members of those organizations. International and national healthcare organizations, such as the World Health Organization (WHO) and the United Nations (UN) have set forth guidelines that affect how not only their individual members, but entire countries behave. As an example, in 1948 the UN created the Universal Declaration of Human Rights that called on all nations and peoples to reaffirm "their faith in fundamental human rights, in the dignity and worth of the human person and in the equal rights of men and women" (United Nations, 1948) and by doing so ensured that each person implicitly had the right to consent to actions taken on or in behalf of the individual. By ensuring that each person in the global community participates in an equal manner and on equal footing, a standard is set that allows individuals the opportunity to exercise their right to say no, and conversely their right to say yes as well.

Other international organizations, such as the WHO, have provided additional and more specific guidelines regarding how issues in healthcare should be handled, and by whom. The WHO charter states that all peoples should benefit from medical, psychological and related knowledge in order to gain the fullest attainment of health and that "informed opinion and active cooperation on the part of the public are of the utmost importance in the improvement of the health of the people" (WHO, 1948, p. 1). In other words, individuals should take an interest in the own lives and gain the knowledge needed to make informed decisions concerning their health and well-being.

The Australian Charter of Health Care Rights (2014) defines seven specific areas of concern for Australian citizens. Those rights include; a right to health care as well as a right to safe and high quality care. The rights also extend to a right to be included in decisions about that care and a right to privacy and confidentiality. The other three stated rights include the right to be shown respect and dignity, the right to comment on care and have the comments discussed, and the right to be informed about the costs and options of the available treatments in a clear and open manner.

The United Nation also developed a document that contains the understanding of just what was expected of the international health care community with the introduction of the Convention of the Rights of the Child. The Convention, according to the United Nation's website became the most "rapidly and widely ratified international human rights treaty in history" (United Nations, 1989). The convention created a set of guidelines for treatment of children as human beings instead of "passive objects of care and charity." Since its creation the Convention has been instrumental in changing how children and youth patients are viewed by the medical community.

Thomas and Weisstub (2008) discusses the ethics and guidelines from different charters and conventions and concludes that many of the organizations have been quite effective in changing cultures around the world regarding health care, and in particular the manner in which children are now viewed and the rights that children are now expected to have.

In 1964, the World Medical Association prepared the Declaration of Helsinki. The Declaration was created as a way of providing guidelines to physicians engaged in biomedical research involving human subjects (WMA, 1964). One of the most intriguing aspects of the Declaration of Helsinki is that for the research subject there is an explicitly stated right to safeguard his or her integrity and that "every precaution should be taken to respect the privacy of the subject and to minimize the impact of the study on the subject's physical and mental integrity and on the personality of the subject" (p. 1). According to the Declaration, the physician is responsible for ensuring that the subject has the right information to make an informed decision, and that information includes the fact that the subject can change his/her mind at any time and for any reason.

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Ethical theories and models

There are always going to be ethical issues within any organization, and when the organization is a medical clinic, hospital, or institution dealing with patients on a daily basis, and those patients are looking for the best medical treatment available, nurses and other practitioners need always be on their best behavior; always acting in an ethical manner. Current literature provides a number of studies addressing the issue of ethics in general and more specifically medical ethics.

This abundance of literature promotes discussion and response, especially in healthcare and healthcare management. Gallagher (2007) helped define areas in which ethical behavior and actions can best be described as being in possession of ethical knowledge, and then acting on that knowledge. He further expounds that ethical perception allows an individual the capability to see a situation which requires ethical reflection. According to Gallagher, ethical reflection allows the individual to gather the knowledge, talked about above, resulting in the determination of the correct ethical behavior, which then allows the individual to 'be' ethical. Gallagher follows the tradition of both Socrates and Aristotle (both Greek philosophers) who believed that ethical behavior was of paramount importance to a stable society. Socrates believed that a person had to become 'self-aware' and for the most part would act in a good manner, while Aristotle believed that while mankind was inherently good, not realizing full potential of that goodness could lead to a life filled with misery and disaster. When Gallagher is defining ethical behavior, he is only continuing the fine tradition started thousands of years ago by these famous Greeks.

Kert, Uz, and Gecu (2014) state that the most effective manner in which to cope with ethical issues is by implementing the ethical decision-making models offered by various researchers. One of the models offered as an example comes from Syracuse University (2015); it offers an 8-step process for making ethical decisions. Those steps include; 1) identifying the problem, 2) identifying the potential issues, 3) reviewing the ethical guidelines, 4) knowing the laws, regulations and policies, 5) consultation with stakeholders and relevant personnel, 6) considering the various available options, 7) listing the consequences of the options, and 8) deciding on a specific course of action that will yield the best results.

Mules (2010) stated there are a number of responsibilities are assumed by businesses as business entities. Medical practices are, in essence, small business entities, therefore they have responsibilities to their patients similar to the responsibilities that businesses have to their customers. According to Mules, the business responsibilities include the interests of stakeholders, customers, management and employees. Comparatively, the medical practice has stakeholders that consist of the doctors, patients, nurses, administrators and even family members. Mules believes that treating the stakeholders in a fair manner and that all stakeholders should know, understand, comprehend and adhere to ethical behaviors is a good model for business. Another study (Keshmiri, Sohrabpour, Farahmand, Kamran, Shahi, Saleh, Shirazi, 2013) determined that a proficient ethical model to follow is one that allows for teamwork-based care through implementing ethical standards, guidelines and values in teamwork for small-group settings.

Code of Ethics, Position Statements, Code of Conduct

Each organization is likely to have a Code of Ethics, Code of Conduct, or a Position Statement that the individual nurse or therapist will be asked to read, understand and comply with. Standards are set for a wide variety of organizations; standards that address many ethical issues such as financial considerations, patient consent, treatment equalities, and as Kulju et al. (2013) stated 'professionalism and self-determination'.

There are differences between a Code of Ethics, Code of Conduct and a Position Statement that need to be understood by the individual nurse or therapist, but primarily all three provide guidance to the individual. As an example the International Council of Nurses (ICN) has a Code of Ethics that is "a guide for action based on social values and needs" (ICN, 2012). According to the ICN website the Code spells out the fact that inherent in nursing is the respect for a patient's right to life, right to dignity and right to be treated with respect. Additionally, the Code of Ethics is presented as a nurse's guide to everyday activities and choices with an emphasis on the nurse's right to say no to any activities that….....

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