Friday, May 08, 2015

Social justice in occupational therapy: Where to from here?

After a multi-year debate there was some small capitulation regarding the social justice language in the AOTA Code of Ethics.  The previous section labeled 'Principle 4: Social Justice' was removed and replaced with a more generic section on 'Justice' that focuses on procedural aspects of the Justice construct.  A passing reference to a social justice construct was included in the Preamble.

It is difficult to know if it is even fair to say 'capitulation' because we have not had precise commentary from the Ethics Commission on those changes.  What we have are the comments of the EC Chair Dr. Lea Brandt who stated

It is correct that in the section on Core Values there is still terminology referring to social injustice.   This reflects the membership feedback which called for inclusion of the concept of social justice while tempering that perspective with a group of members who requested to have the term removed.  The term “Social Justice” was removed from the Principles and Standards of Conduct section which outlines the enforceable areas of practice, but was retained in the aspiration section of the Code.  
 In short, standards which contained language that could appear ambiguous to some or more challenging to enforce were removed or modified; however aspirational language related to social justice concepts was relocated to the Preamble section accommodating the large number of requests to strengthen and include this language consistent with the profession’s Centennial Vision.  The intent in doing this was to develop a Code which includes further clarification of the potential interface between the professional Code of Ethics and state licensure laws and the roles and responsibilities of each.

One of the primary arguments about a social justice requirement was that it could not be enforced.  The EC attempted to separate enforceable principles from non-enforceable values but actually created an illogical division that has concepts listed in both.  Obviously, enforceable and non-enforceable are mutually exclusive divisions and that makes the current Code very confusing.

For example, Justice is listed in both divisions.  How can Justice be both an enforceable principle and a non-enforceable Core Value?  An excellent analysis of this illogical classification scheme was posted by Alex Duran and can be viewed here.

I understand the intent to separate Non-Enforceable (aspirational) v. Enforceable ethics, but it appears to have been done poorly.  Perhaps a model that attempts a more clear distinction between the two categories would be the APA Code of Ethics.  The APA Code does not seem to re-label and confuse the two categories.  Rather, the Enforceable Ethics (Standards) are rather specific and relate to very concrete practice and research oriented concerns.

The APA Ethics Director stated "The distinction between aspirational and enforceable is central to the code's structure and differentiates between the ideals and goals to which psychologists aspire and the rules by which psychologists must abide. When adjudicatory bodies blur this distinction, psychologists may inappropriately be held responsible and possibly disciplined for not fulfilling the profession's ideals and striving toward its highest goals."

As the AOTA Code of Ethics is unfortunately embedded in the license law of several states by reference, it is critical that the Code is clear and coherent.  In this there has been a clear failure.

So although there have been improvements with the removal of some of the Social Justice language, large problems have been created with an illogical division of enforceable principles and non-enforceable values.  With functional classification schemes readily available (APA), it is disappointing that this kind of error was made.

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What remains problematic in this entire ethical debate is that there continues to be a disconnect for many American therapists about what the social justice construct actually represents and what it means when it is adopted as a value.  There are some agenda-driven therapists who are fully aware of the implications of their advocacy for a social justice concept but there are also large numbers of people who go along with it because it 'sounds' good.  I am not certain that much has changed since 2011 when the debate started on OT Connections - at that time many people were arguing that social justice was not a political construct and they thought it just meant that we should try to help poor people.  Of course the issue is not the objective (trying to improve the lives of people) but the problem is with the methodology (redistribution and governmental control).

It is my wish that American therapists would watch or read the news of the 2015 British elections and see the unfortunate result of a health system that has become hopelessly intertwined with politics.  The commentary from UK colleagues and even the COT is telling and demonstrates the angst and concern that is created because the conservative party performed much better in elections than was initially predicted.

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As an interesting and related point of reading, I encourage occupational therapists who are still confused about what the social justice construct represents to read Adam Swift and David Brighouse's recent 'scholarship' on the topic.  They are promoting the concept that "familial relationship goods" are unfairly distributed because some families are able to confer advantages based on values, relationships, opportunities, etc.  This hit the lay press last week associated with Swift's appearance on a radio show where he was discussing the 'unfair advantage' that was conferred by some families reading bedtime stories to their children - so of course the extension of this bizarre thinking is that reading bedtime stories should not be allowed.  It is fortunate that the lay press grabbed a hold of the odd 'ban on bedtime stories' because sometimes it takes just such a soundbite to bring the agenda and dangerous thinking to the fore.

I don't expect that Swift and Brighouse actually want to control people's bedtime story routines with their children, but this type of thinking and 'moralizing' helps to prop up the notion that the State has to be an arbiter of fairness and distribution because there is no other mechanism to ensure equal distribution of "familial relationship goods."

I wish that this soundbite was available during the debates on social justice in the Code of Ethics.  I would love occupational therapists to explain how they are supposed to "abide by the highest standards of Social Justice" (as was required in the 2010 Code of Ethics) when Social Justice crusaders state that we need to make the distribution of familial relationship goods "fair" for everyone.

I already blogged about this in context of Melissa Harris Perry's objectionable statement that children don't belong to their parents and need to be raised by a collective community.  This remains an issue for the Ethics Commission to address, because it is very difficult to understand how Dr. Brandt can continue to state that such collectivism is a Core Value of the occupational therapy profession when so much evidence points to the contrary notion that the profession has always emphasized autonomy and individual responsibility.

My opinion is that this Social Justice conversation should continue as long as there are elements in the (USA) profession who mistakenly believe that it is a Core Value.

And now we have the introduction of a new unfortunate confusion about what is an enforceable principle and what is a non-enforceable Core Value.  There is work still to be done.

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