Social justice follow up: Brass tacks for the occupational therapy profession

This post is a follow up to the 2011 Social Justice Debates in Occupational Therapy and also in general response to the ongoing conversation on this topic that can be found on the OT Connections public forums.

Here are some Monday brass tacks that I hope will generate some thought and conversation.  These are not the same brass tacks that address the concern about what to do with the social or occupational justice heathens who have made public proclamations on forums and on websites; these are brass tacks that hopefully start a conversation on how the social justice provisions have actually been operationalized in the occupational therapy profession.  There is a lot to talk about from different perspectives, to be sure.

In context of this old and lengthy conversation, and as reported by the original author of the motion, one of the significant concerns with this motion was that it was de facto law in several states due to its inclusion in several practice acts by reference.

A couple years have gone by, so isn't it a good opportunity to see how this has 'mattered??'  As has been discussed, there are academic concerns regarding definitions and morality of 'social justice' and then there is the street-level concern about how this all impacts practice.  Over the past week I have made a soft attempt at determining how it has impacted practice.

Taking a look at AOTA public notification of enforcement re: ethical violations, there are no current listings of violations of Principle 4 (social justice principles) since the 2010 document has been in effect.  However, it is noted that many recent determinations were still using the 2005 standards so it still may be too early to determine how Principle 4 is being considered.

That led me to start a of state-by-state analysis for those disciplinary cases that cite social justice provisions in the AOTA code of ethics. 

I struck out.

So what does that mean?  Well, first of all my search-fu may just be weak, and in order to conduct a proper analysis I would have to FOIL all the documents from states to see how/if the standards were applied, but that is just a hot mess of a struggle that would probably require funding in order to complete.

I contacted AOTA to see if they (as a non-public entity but still operating with an apparent quasi-regulatory function) would release documentation of their ethics case decisions and was told that the only information released would be whatever is posted in the publications (and presumably on the website as well).  That means that they don't release information.

Based on these preliminary efforts these are my conclusions on whether or not any of this 'matters' from the brass tacks perspective of ethics enforcement:

1. It still might be too early to tell, but so far there is no evidence that social justice ethics provisions are being cited in occupational therapy disciplinary cases.  Or the evidence may be hard to find.  Who knows.  The fact that I am typing 'who knows' is itself a concern.

2. AOTA decisions that MIGHT include reference to these provisions are secret, except to the degree that you can go back and look at 'Findings of Fact' that have been published by a State regulatory body.  Not exactly easy to do.  Secret is a problem in that these provisions have become de facto state law for many people.

3. There may be some legal basis for a complaint against a State for adopting ethics statements that practitioners are held up to when in fact there is no evidence that the State itself (via its Board) or any people being held to those standards had any input into the development of or commentary on those ethics statements.  In English, someone who is not an AOTA member is being held to the standards of an AOTA member when they could have explicitly opted out of the AOTA standard because they disagreed with the AOTA ethics statements.  Or they could have been kicked out.  That is quite a conundrum!

4. There are several points of internal consistency that need to be explored relating to social justice aspirational provisions in the ethics statements (Principle 4) and provisions relating to fidelity toward colleagues (Principle 7).  The OT Connections forum threads alone, over time, have really magnified the potential threat to Principle 7 that has occurred by codifying Principle 4.

5. The larger question emerges on the 'fairness' (I can't believe I am using that word) of non-transparency of  quasi-regulatory non-public bodies.   Here it is important to make discernment between codes of conduct which are rather specific and legally based (heh, mostly) and the more broad and sweeping principles in a code of ethics.  This is yet another debate.

6. There is a technical and practical issue of whether or not a person concerned about these issues has 'standing' unless they have been subject to a disciplinary action.  So looking at this from a pragmatic point of ethics decision analysis might be somewhat moot, at least until a regulatory or quasi-regulatory body has applied their boot to your posterior.

Debate on ethics provisions seems far from closed - there are so many issues to explore.

Christopher J. Alterio, Dr.OT, OTR

(also published on my blog for purposes of controlling perpetuity)


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