++
“Ethics and equity and the principles of justice do not change with the calendar.”
—D.H. Lawrence
++
LEARNING OUTCOMES
By the end of this chapter, readers will be able to:
6-1. Identify laws and policies that affect older adults, including policies on ageism and ethics of billing and productivity.
6-2. Determine the legal needs of older adults for advance care planning, end-of-life decision-making, and their ethical implications.
6-3. Analyze circumstances and factors that contribute to elder abuse and neglect.
6-4. Determine the responsibilities of occupational therapy practitioners in addressing elder abuse.
6-5. Critically reflect on key ethical issues relevant to the experience of older adults.
6-6. Apply ethical decision making to a case study regarding legal and ethical issues faced by older adults.
6-7. Explain the importance of multidisciplinary and interprofessional teams in ethical decision-making.
++
Mini Case Study
Ms. Parks is a 64-year-old female referred to outpatient occupational therapy for imbalance and frequent falls during activities of daily living (ADLs). During the history portion of the assessment, Ms. Parks reported she was essentially homeless and went back and forth between her ex-husband’s home and her brother’s home. She reported that her brother would yell at and berate her and sometimes take her money. However, when she was at her ex-husband’s home, he would hit and shove her. She reported that sometimes her ex-husband would shove her so hard that “my head hits the wall.” Ms. Parks quickly added, “But don’t report me because then I won’t have anywhere to live,” and stated that she was afraid of what her brother or ex-husband would do if she reported them. The initial evaluation findings indicated the client’s imbalance was caused by central nervous system impairment, likely from undiagnosed head trauma as a result of the abuse. The occupational therapy practitioner could not persuade the client to agree to report the abuse. Later, the occupational therapy practitioner recounted Ms. Parks’ story to the outpatient facility’s manager, who was also the social worker, asking for advice on how to proceed. The manager shrugged and stated, “If an adult of sound mind and in control of her own affairs requests to not report abuse, there is nothing I can do.”
Provocative Questions
What are the legal and ethical issues at stake in this scenario?
Which ethical principles and standards from the American Occupational Therapy Association (AOTA) Code of Ethics (AOTA, 2020a) apply to Ms. Parks’ case? Alternate: Which aspects of the World Federation of Occupational Therapists Code of Ethics apply? Which aspects of occupational therapy codes of ethics from around the world apply?
Is the social worker’s assertion correct regarding reporting the abuse? Why or why not? What do the laws in your location say about mandatory reporting of abuse?
++
Occupational therapy practitioners enter the profession as generally ethical people who want to do good in the world. However, the issues they will encounter are often ...