Annotated Bibliography

Reference: Sheirton, Linda S. et al. “Ethical analysis of cases in occupational and physical therapy practices.” 2007. Medicine, Health and Philosophy. Vol 10: pp301-310.

This article discusses five different cases of misconduct or errors in OT and PT practices. They analyze each event in detail, its impact on the patient, practice and then suggest preventative strategies. Each case can be used as a standard in the profession for upholding principles found in the code of ethics. One such case was when a patient slipped from a wheelchair, broke her wrist and the incident was not reported. Not report an incident of omitting vital information in a chart is fraud. This also violated the principle of nonmaleficence. Since the accident was reported, the patient was not able to get her wrist splinted and treated right away. So aside from the error of not fastening the belt on the wheelchair, the OT was neglectful and fraudulent.  The authors cite a voluntary reporting systems to alleviate this problem.  By reporting and admitting her mistake, getting treatment for the patient right away, there would be a better outcome for both the practitioner and the client. 

How I would use this in practice: A mistake is a lapse in judgement or unintentional oversight. OTs who report their mistakes can learn from them and should not be afraid punitive action since her mistake was not planned.  Although the mistake was egregious, the ethics board may choose not to report her to the state. If it becomes a pattern, then she would be at risk to lose her license. However, if her performance is normally excellent and remains so after a period of probation, the AOTA may only censure her briefly.  The board would expect her re-train herself on safety and practice taking precautions so that the error is not repeated again. If I saw a fall in a clinic, I would report it.  I would also be mindful to double check patients who are frail. I saw in a rehab facility an wrist band in yellow with black letters that said “FALL RISK.” I would make sure each patient that was unsteady on their feet had this.  Even small details like this arm band make a big difference. Above all, most of the OTs in this article seemed to be trying to do too many things at once or be overloaded. Taking time to double check and stay focused on one client at a time.

Reference: Levack, William MM. “Ethics in goal planning for rehabilitation: a utilitarian perspective” Clinical Rehabilitation. 23. 4 (Apr 2009): pp345-51.

Summary: This article discusses approaching setting goals for clients using utilitarian principles. Essentially, the is a very pragmatic and economic approach that requires the OT to set goals based on the resources, time constraints, and ability to determine the maximum benefit for the patient. There are other factors that weigh heavily on setting goals such as right to autonomy, client factors and social justice.  However, being practical and be very observant may stop the OT from setting goals that are out of reach. The author demonstrates that even the most skillful intervention methods will not improve impairments that haven’t responded to treatment. He supports the use of technology to help a client with performance. Furthermore, he explains that clients can also seek support from social groups of people who have similar limitations.

Use in my career: Utilitarianism is interesting in approach goals because it acknowledge the scope of occupational therapy. While I might wish my patient to have all normal capabilities in his life, it’s unethical to make full functionality a goal if it is unrealistic. For instance, a young girl who needed hand surgery because of infection was told by her doctor that she can no longer do gymnastics. She lost some muscle and nerve tissue and then came to the OT clinic. My goal for her would be to be back to function in all basic ADLs. In terms of athletics, I would encourage sports like soccer or swimming where she doesn’t need to put pressure on her hand. I would suggest she volunteer with the para-olympics as well as making friends with others who don’t do gymnastics.  When I ask for her to comment on her progress, I would want her to be hopeful about having a happy, healthy and productive life despite the loss of strength. Moreover, in other cases, if progress is very fast, it may be possible to make the goal higher so as not to deter the client from continuing a fast paced recovery.