Examples of Practice Scenarios
Personal Benefit
A company that supplies wheelchairs has offered funding for an occupational therapy course.
Would this be considered a conflict of interest?
When determining whether to accept this kind of gift, an occupational therapist should consider:
- The motives of the giver;
- Any constraints or conditions attached to the gift;
- The potential or perception of a conflict of interest; and/or
- Employer policy regarding gifts.
Performance Indicator 4.1 states an occupational therapist should refrain from exchanging gifts,
hospitality and other benefits to avoid creating expectations for the type of care a client will receive,
and prevent the perception that the occupational therapist’s integrity may be compromised. Gifts from commercial sources have the potential to create an obligation and a loss of objectivity. For instance, a gift such as this could influence the occupational therapist’s discussion with clients about their choice
of vendor. Overall, such an offer needs to be declined (unless, perhaps, it was part of a project that was
open to all occupational therapists and the selection was made by a neutral party).
An occupational therapist should identify these issues and discuss them with his/her supervisor to raise awareness of possible conflicts and assist in their decision making. The company may offer the funding with a motive of influencing the occupational therapist to recommend the company to his or her clients when they are purchasing equipment. It may also add conditions to the offer that would compromise the occupational therapist’s professional judgement. For instance, the offer may be on condition that the occupational therapist will be required to work in a certain area of practice, location or industry upon completion of the course.
Self-Referral
Alice is an occupational therapist operating her own private practice but has been employed at a
rehabilitation centre. She is wondering if she could give out her private business cards to clients she
sees at the rehabilitation centre.
An occupational therapist will avoid self-referral or soliciting clients for his/her private business, from
clients seen at his/her place of employment. Where this is unavoidable, performance Indicators 6.1-6.3 states that the occupational therapist will disclose, give clients options and retain records to show that a disclosure was made. It is not appropriate for the occupational therapist to refer clients from their employment to their private practice. As the performance indicator states, the occupational therapist’s personal interests could interfere with his/her professional judgement or the client’s best interests. For instance, the OT may advocate for an earlier than usual discharge to enable private services to begin, or it may be perceived that this is the case. In addition, Ontario Regulation 226/96: General – Part V: Advertising, does not permit direct solicitation to individual clients. However, an occupational therapist who has a practice separate from hospital employment would be able to distribute their advertising materials to referral sources such as doctor’s offices or through other professionals.
Stakeholder Relationship
An occupational therapist has worked in a rehabilitation centre for a long time and is considered an expert in physical disability rehabilitation. She is well known and respected by the local community and is often invited to speak about physical disability at conferences. In one instance, she has been invited to speak at a conference and present a paper on effectiveness of assistive devices to persons with physical disabilities.
After accepting the invitation, she receives conference materials and learns that each session has a corporate sponsor. Her session is being sponsored by a company that develops wheelchairs among other products. Speakers are also provided with the company logo and are requested to use it in all their presentation slides and handouts. They are also requested to acknowledge and thank the sponsors for the generous sponsorship. Should the occupational therapist agree to present?
It is important to understand that clients seeking health care such as occupational therapy services are typically in a vulnerable position. They look to the occupational therapist for assistance and hold that individual in a position of trust. The public trust that the occupational therapist as a health care professional will act in the client’s best interest. As such, an occupational therapist is expected to practise in a highly ethical, transparent and client-centred manner. Performance indicator 7.1 states that an occupational therapist will recognize and ensure that the primary objective of interactions between the occupational therapist and companies, manufacturers or vendors are in the best interest of the client rather than the private interest of either party.
Further, Performance Indicator 7.2 states that an occupational therapist’s primary obligation is towards the client. Relationships with stakeholders will only be made if they do not affect the integrity, trust and confidence in the occupational therapist/client relationship. In this scenario, the dilemma is whether the occupational therapist is using her professional status to implicitly endorse the company. The occupational therapist might also be pressured to slant the presentation in a particular way to avoid upsetting the sponsor. Using the company logo on handouts and presentation sends the message that the company might have influenced the content of the presentation. This kind of relationship should be avoided unless there are enough safeguards to highlight the objectivity of the occupational therapist (e.g., a disclaimer in the written materials and handouts indicating that the occupational therapist had no connection with the sponsor).
Dual or Multiple Relationships
Paul Smith, an OT, works in a mental health clinic where he has gained a lot of expertise in psychotherapy. His best friend Kate talks a lot about issues with her husband, Andrew, and their intimacy problems. Over time, Kate convinces Andrew to seek therapy. She asks Paul, the OT for a referral, but Paul mentions that finding a therapist can be difficult so he would be willing to see Andrew.
When Paul starts to see his friend’s husband in therapy, Kate mentions at lunch with Paul that her husband has a chronic drug problem that she hopes he has mentioned in therapy. In addition, Andrew informs Paul during therapy that his wife is physically abusing their child. Andrew also wants to bring up issues about his sexual relationship with Kate in therapy, but he feels he can’t share certain things with Paul because he fears the influence of Paul’s friendship with Kate.
In this scenario, there are a number of role conflicts that complicate the situation. The occupational therapist must hold confidential information that he hears from Andrew but he cannot share with Kate. While Paul may have very good processes for protecting confidential information, it can still be easy to slip up and forget who has shared what when he hears stories about the same events and relationship from two different people.
Performance Indicator 5.1 states that the occupational therapist will identify when dual or multiple roles affect or could be reasonably perceived to affect one’s judgement, or ability to be impartial and neutral in the therapeutic relationship (e.g., business partner, friend, relative).
Further, Performance Indicator 5.4 states that the occupational therapist will avoid entering into a
therapeutic relationship with family, colleagues, or friends unless no other option is available to provide
the required service. When that happens, the occupational therapist will give full disclosure to the client and any third party payer of the potential boundary and conflict of interest issues involved. By agreeing to start a therapeutic relationship with a friend’s spouse, Paul has not only risked a boundary crossing, but may also compromise his judgement leading to a conflict of interest. Paul should have explored other options, such as another occupational therapist or health service professional to provide the required service to Andrew.