Resolution of Business Ethical Dilemmas

THE RESOLUTION AND THE METHODS USED

After detailed discussions with the client and her family, I discontinued home-based occupational therapy services and referred the client for outpatient rehabilitation.

Jonsen, Seigler, and Winslade (1998), Purtillo (1993) and, Trompetter, Hansen, and Kyler-Hutchinson (1998) have all proposed several methods or processing tools to analyse ethical dilemmas (6, 7, 8). Kornblau and Starling (1999) also proposed a framework for ethical decision-making. It was called the CELIBATE method (an acronym for ‘Clinical Ethics and Legal Issues Bait All Therapists Equally’). The acronym acts as a cue for the user of the framework with each letter representing an aspect for analysis (for example: C for clinical situation, E for ethical issues, L for legal issues, I for information, B for brainstorming action steps, A for analysing action steps, T for taking the action and E for evaluating the results) (5).

In the course of analysing and applying a methodology to resolve my ethical dilemma, I charted my ethical course via a framework. Based on this model, we can divide the entire ethical process when faced by a dilemma into three phases, namely the ethical encounter, the ethical loading and ethical unloading.

The ethical encounter: This phase as applied to my case has been discussed under the section titled ‘The case scenario’. The parties involved are the client, my self, the home health agency that employs my services, the CMS, the State Occupational Therapy Board due to its judiciary powers over the practice of occupational therapy, the American Occupational Therapy Association (AOTA) as it regulates the profession and sets codes of ethics (9), the scope (10) and standards of practice (11); the client’s family, and the community as a whole based upon the potential impact of my services (or the lack of services) on my client’s health and well-being. In the encounter phase, we face all the interacting human and/or organisational components of the ethical issue.

The ethical loading: In this phase we analyse the various issues facing us. Whether the law has been violated, or is at risk, or was there just an ethical problem with no legal implications? My dilemma involves whether or not to continue services although there is a medical necessity, but the client may not necessarily meet the coverage criteria for payment. In this case, one may clearly recognise both ethical and legal issues. Legal issues are based upon Medicare and state practice acts governing the profession as well as the AOTA code of ethics (9) and standards of practice (11). This phase bears the load to introspect and discover legal and ethical violations or risks and analyse methods and the future course of action. We have discussed the ethical issues pertaining to my client in the section titled ‘Ethical principles at risk’. In this case, we determined that the theory of deontology best guided our course of resolution.

The ethical unloading: Based upon my realisation and analysis of the ethical-legal aspects involved, I mainly geared my actions toward ethical resolution since there were no legal violations as yet and no separate legal actions were warranted other than those implied by ethical actions. My ethical actions were aimed at mainly upholding deontological principles by following my professional duty as perceived under Medicare and state practice acts, and by not interfering with the regulation with my own interpretation and attempt to liberalise it. I chose to rather use the regulation in its most restrictive form in order to ensure that no confusing elements could cause further dilemmas. This upheld the cause of justice, veracity, and my fidelity toward the law that governs my professional practice.

With the ability to visit her husband at the nursing home at will, the client’s autonomy was upheld as well. Ms EH was also counselled on her options to receive services under Medicare Part-B plan at an outpatient rehabilitation clinic or other qualifying health care facilities. Fortunately, the facility where her spouse was admitted agreed to also treat her as an outpatient. The client found this acceptable and feasible as well.

My course of action also ensured non- malfeasance and beneficence by ensuring continuity of services desired and needed by the client in an environment that was acceptable to her. It is in this phase where I “unloaded” my ethical burden through actions that I chose based upon my prior experience, training and/or conscience.

As with any clinical case, we may view the “ethical encounter” as a phase where we focus on the demographics and situation at hand. The “ethical loading” phase mainly deals with recognising the ethical and legal issues involved (like the diagnostic process), and investigating and selecting the best course of action (formulating a plan for intervention). Finally, the “ethical unloading” phase involves the application of actions/ interventions with the aim of resolving an issue (outcome). Therefore, this phase must also reflect on the effectiveness of the actions/ interventions in meeting the interests of all parties in the situation.