Academic journal article New Zealand Journal of Occupational Therapy

How Has Ethical Practice Been Shaped for Occupational Therapists Practising in Aotearoa New Zealand? A Foucauldian Discourse Analysis

Academic journal article New Zealand Journal of Occupational Therapy

How Has Ethical Practice Been Shaped for Occupational Therapists Practising in Aotearoa New Zealand? A Foucauldian Discourse Analysis

Article excerpt

Abstract

Ethical practice is a site of tension for occupational therapists due to the constant balancing between being an ethical individual and an ethical practitioner. One of the ways this tension has been addressed is through the provision of Competency for Registration documents and a Code of Ethics to guide how ethical practice should appear. These grey documents were examined using a Foucauldian discourse analysis. The findings indicate that over time a practical (utilitarian) interpretation of ethics became the dominant guiding force, one that was strengthened by connections to the law. This dominance is discussed in relation to other interpretations of ethics that influence occupational therapy practice.

Key words

Code of ethics, grey literature, occupational therapy

Reference

Silcock, M., Campbell, M., Hocking, C., & Hight, C. (2017). How Has Ethical Practice Been Shaped For Occupational Therapists Practising in Aotearoa New Zealand? A Foucauldian Discourse Analysis. New Zealand Journal of Occupational Therapy, 64(2), 13-21.

There are many sites of ethical tension that appear in occupational therapy practice, such as conflict with personal moral principles, dealing with constraints created by organisational or institutional rules and managing dilemmas over competing courses of action (Bushby, Chan, Druif, Ho, & Kinsella, 2015). There has been an ongoing unease in the way the profession manages these ethical tensions both at the level of the individual (Barnitt, 1993; Kinsella, Park, Appiagyei, Chang, & Chow, 2008) and as a collective (Mattingly & Fleming, 1994; Molke, 2011; Townsend, 1998). This paper presents an argument that the legislated and formally directed ways of governing occupational therapists' practice also contributes to the ethical tensions we are required to manage in our day to day work. The ways in which we are expected to demonstrate competent ethical practice has instilled an understanding of ethics from a particular, normalised standpoint. These expectations have not acknowledged the complexity of the ethics in day to day practice, nor have they allowed for other ways of interpreting ethical practice to appear. These findings are part of a wider PhD project that employs Foucauldian discourse analysis to examine what is shaping the occupational therapy profession in Aotearoa New Zealand.

Background

Internationally, from the 1990's to the early 2000's, the main English language occupational therapy journals presented ethics as part of practising occupational therapy in different ways. These included the way personal values and principles connect with ethical reasoning and conduct (Atwal & Caldwell, 2003; Barnitt & Partridge, 1997; Greene, 1997), the impact of legal responsibilities on ethical decision making (Brockett, 1994), and the linkages between ethics and evidence based practice (Holm, 2000), client centred practice (Hammell, 2001), and clinical reasoning (Fondiller, Rosage, & Neuhaus, 1990; Mattingly, 1991; Munroe, 1996; Schell & Cervero, 1993). Additionally, there was a political connection to ethics emerging with the introduction of concepts of social justice and activism in occupational therapy (Townsend, 1993), which recognised ethical practice as part of a wider social responsibility. Since then, although ethical practice remains a prominent concern for occupational therapists, there has been limited scholarly attention to the ethical tensions of practising occupational therapy.

A recent systemic review of international English language occupational therapy publications spanning 13 years (2000-2013) was conducted to stimulate a renewed focus on ethical tensions in occupational therapy practice (Bushby et al., 2015). In the 32 published papers included in the review, (none of which were from Aotearoa New Zealand), ethical tensions covering many areas of practice were discussed, including: resourcing; confidentiality and truth telling; client safety; working with vulnerable people; interpersonal conflicts, upholding professional standards; and practice management. …

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