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Sean Loran

Case 70, pg. 107: Dr. Zaborowzki referred Mr. Smith to you for a very specific treatment
modality. In your review of Mr. Smiths chart, you discover Mr. Smiths diagnosis. You are
aware that the specific treatment ordered by Dr. Zaborowzki is contraindicated for persons with
Mr. Smiths diagnosis.

Ethical Dilemma Worksheet

(1) What is the problem?

The problem is that the doctor has given me an order that would cause direct harm to Mr. Smith.

(2) What are the facts of the situation?

Mr. Smith is Dr. Zaborowzkis patient.
Dr. Zaborowzki has given me an order to treat Mr. Smith using a specific modality.
The specific modality I have been given an order for is contraindicated for persons with
Mr. Smiths diagnosis.
It is unethical for me to knowingly cause harm to the patient.

(3) Who are the interested parties?

Mr. Smith
Dr. Zaborowzki

(4) What is the nature of their interest? Why is this a problem?

Interested Parties Their Interests

Mr. Smith Personal-wants to feel better, does not want a set-back, wants
to get back to being as functional as possible
Economical-possibly wants to go back to work
Dr. Professional-wants to maintain reputation
Zaborowzk Intellectual-wants to order the correct treatment
i Business-does not want to get into a lawsuit
Economical-wants to keep license and keep working as a
doctor, does not want the costs of a lawsuit
Personal-cares about Mr. Smith and wants him to get better,
does not want to cause harm to Mr. Smith
Me Professional-wants to maintain reputation
Intellectual-does not want to question a doctor with a higher
level of education
Personal-cares about Mr. Smith and wants him to get better,
does not want to cause harm to Mr. Smith
Economical-wants to keep license and keep working as an
OT, does not want the costs of a lawsuit
Business-does not a lawsuit
Payers Business-does not want a lawsuit
Economical- does not want the costs of a lawsuit
Facility Professional-wants to maintain reputation
Business-does not want a lawsuit
Economical-does not want the costs of a lawsuit

(5) Is there an ethical issue? Yes!

Does it violate a professional code of ethics? Which section(s)?
o Beneficence
A. Provide appropriate evaluation and a plan of intervention for recipients
of occupational therapy services specific to their needs.
F. Take steps (e.g., continuing education, research, supervision, training) to
ensure proficiency, use careful judgment, and weigh potential for harm
when generally recognized standards do not exist in emerging technology
or areas of practice.
o Nonmaleficence
A. Avoid inflicting harm or injury to recipients of occupational therapy
services, students, research participants, or employees.
C. Recognize and take appropriate action to remedy personal problems
and limitations that might cause harm to recipients of service, colleagues,
students, research participants, or others.
H. Avoid compromising rights or well-being of others based on arbitrary
directives (e.g., unrealistic productivity expectations, falsification of
documentation, inaccurate coding) by exercising professional judgment
and critical analysis.
o Justice
K. Report to appropriate authorities any acts in practice, education, and
research that are unethical or illegal.
o Veracity
D. Identify and fully disclose to all appropriate persons errors or adverse
events that compromise the safety of service recipients.
o Fidelity
B. Address incompetent, disruptive, unethical, illegal, or impaired practice
that jeopardizes the safety or well-being of others and team effectiveness.
G. Refrain from communication that is derogatory, intimidating, or
disrespectful and that unduly discourages others from participating in
professional dialogue.
H. Promote collaborative actions and communication as a member of
interprofessional teams to facilitate quality care and safety for clients.
I. Respect the practices, competencies, roles, and responsibilities of their
own and other professions to promote a collaborative environment
reflective of interprofessional teams.
J. Use conflict resolution and internal and alternative dispute resolution
resources as needed to resolve organizational and interpersonal conflicts,
as well as perceived institutional ethics violations.
L. Refrain from actions that reduce the publics trust in occupational

Does it violate moral, social, or religious values?

o Yes it could violate moral, social, or religious values. Knowingly causing harm to
other is against many peoples moral and/or religious values as well as the values
of society.

(6) Is there a legal issue? Yes there is violations of 201 KAR 28:140.
Practice act/licensure law and regulations? Which sections?
o Section 1
(5) An OT/L or an OTA/L shall report any illegal, incompetent, or
unethical practice to the appropriate authority.
(13) An OT/L or an OTA/L shall include those people served in the
intervention planning process.
(16) An OT/L or an OTA/L shall inform those people served of the nature
and potential outcomes of therapy and shall respect the right of potential
recipients of service to refuse therapy.
(18) An OT/L or an OTA/L shall take all reasonable precautions to avoid
harm to the recipient of services or detriment to the recipient's property.
o Section 2
(7) An OT/L or an OTA/L shall inform the referring source when any
requested occupational therapy service is contraindicated, in the
professional judgment of the licensee, and may refuse to carry out that
(8) An OT/L shall competently provide the following minimum services:
(a) Proper interpretation of all referrals
(10)(a) An OT/L or an OTA/L shall not provide occupational therapy
services in an incompetent manner. (b) Incompetent practice includes:
1. A lack of the knowledge, judgment, or skill necessary to perform those
modalities, methods, and techniques that come within the practice of
occupational therapy
Check the CELIBATE Checklist for other possible legal issues.
Malpractice and modalities without training are other possible legal issues.

(7) Do I need more information?

I think I would need to know why the modality was contraindicated (what are the risks). I would
want to know if Dr. Zaborowzki was aware that the modality was contraindicated. I would do my
best to do thorough research of the literature to make sure that the modality is contraindicated for
the diagnosis before speaking with Dr. Zaborowzki. If there was conflicting literature and Dr.
Zaborowzki and I had different sources, I would want to speak with someone so I would be
aware of the legal risks of my actions before I preformed the modality.

(8) Brainstorm Possible Steps:

1. Double check with the patient to make sure the diagnosis is correct in the chart.
2. Double check the literature to make sure the modality is contraindicated for people with this
3. Double check with Dr. Zaborowzki to make sure he/she wrote the order correctly.
4. If Dr. Zaborowzki says he/she did write the order correctly, inform them in a respectful way
that the literature contraindicates people with Mr. Smiths diagnosis.
5. Do not preform the modality.
5. Look up the facilitys policy for reporting incompetence.
6. Report the incident to my supervisor.

(9) Analyze Action Steps:

Another possible set of actions other than the one listed in number (8) is to perform the modality
because that is what the doctor ordered me to do. I think this is the wrong step to take because it
would knowingly cause harm to Mr. Smith. Going ahead and preforming the modality could lead
to a lawsuit and eventually a loss of my job and/or license. Dr. Zaborowzki would mostly likely
get sued for malpractice as well and have his/her license taken away. The facility would have to
go through all of the legal process and it would cost them a lot of money. The payers would not
reimburse me for the modality and could have to pay for subsequent medical expenses if serious
harm was done to Mr. Smith. Worst of all, Mr. Smith would suffer a set back to his recovery and
could suffer from more pain. This could also have a financial impact on him if this delays him
from going back to work. I think the right choice of actions to take would be to complete the
steps outlined in number (8). I think this would be the best way to make sure no harm is done to
Mr. Smith and I had exhausted my resources before going to Dr. Zaborowzki. I would also talk to
Dr. Zaborowzki respectfully and report the situation to the appropriate people to make sure it is
dealt with properly. This would put me and my beliefs at easy knowing I took the moral and legal
correct action.

(10) Choose a Course of Action:

The Rotary Four-Way Test:
o Is it the truth? Yes, I think this is the way I would truly act.
o Is it fair to all concerned? Yes, I think it is fair to everyone. Client safety comes
first and I would just be looking out for Mr. Smith.
o Will it build goodwill and better friendships? This has the potential to harm my
working relationship with Dr. Zaborowzki, but I think I would be concerned about
the safety of Mr. Smith and Dr. Zaborowzkis future clients.
o Will it be beneficial to all concerned? I dont think it would be beneficial to
everyone, but it would cause the least amount of harm. The facilities could also
not take any action on Dr. Zaborowzki and he/she could use it as a learning
It is win-win? I dont think it is win-win, but its better than lose-lose.
How do I feel about my course of action?
I am happy that I did not cause harm to Mr. Smith, but I hate having to report Dr.
Zaborowzki. I do not know the consequences he/she will face. I just hope that it doesnt
have a major impact on Dr. Zaborowzkis career or life.