Ethical Tensions in Occupational Therapy Practice: Conflicts and Competing Allegiances.
Evelyne Durocher, Elizabeth Anne Kinsella
PMID 34595932WHAT IT FOUND
Seven occupational therapists described ethical tensions arising from competing allegiances to clients, employers, colleagues, and regulatory colleges.
Common conflicts included balancing client autonomy with safety risks, navigating gift-giving guidelines, and managing value clashes with colleagues or employers.
Key findings
01Participants reported five main areas of tension: client autonomy vs safety, client vs therapist values, colleagues vs clients/regulatory mandates, therapist values vs employer directives, and clients vs regulatory mandates.
02Tensions frequently arose in discharge planning and community reintegration when respecting a client's autonomous choices (such as driving or living alone) was perceived to compromise safety for the client or others.
03Regulatory guidelines regarding gift acceptance and dual relationships (knowing clients outside of work) were often experienced as conflicting with the desire to maintain therapeutic rapport and respect cultural or social norms.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The sample was very small (n=7) and geographically limited to Southwestern Ontario, so findings are not generalizable. The study was a secondary analysis of an exploratory case study, not designed specifically to examine competing allegiances from the start. Participants were recruited through leaders in key organizations, which may have skewed the sample toward those already engaged in professional networks.
Declared interests
The study was approved by the research ethics board at Western University. No specific funding sources or conflicts of interest were declared in the provided text.
The easy way to misread this
Do not treat these findings as evidence that ethical tensions cause specific negative patient outcomes or that certain interventions resolve them. This is a descriptive study of therapists' experiences; it does not measure patient safety, satisfaction, or clinical efficacy, nor does it test solutions for moral distress.