Ethical tensions related to systemic structures: Implications for therapists' enactment of an ethics of care

Background: Ethical challenges arise daily in healthcare practice. Such challenges are frequently related to aspects of practice that are shaped by the structure of healthcare system or policy-determined service attributes,... [ view full abstract ]

Background: Ethical challenges arise daily in healthcare practice. Such challenges are frequently related to aspects of practice that are shaped by the structure of healthcare system or policy-determined service attributes, yet little research focuses on these issues in occupational therapy practice.
Methods: Based on a comprehensive scoping review (Bushby et al., 2014), in this work we employed collective case study methods (Stake, 2000, 2006) to examine ethical tensions reported by occupational therapists practising in different settings in Southern Ontario, Canada. In this paper we focus on the predominant category of ethical tensions emerging in the empirical work – ethical tensions related to systemic constraints and resource issues. We applied an ethics of care (Tronto, 1993) theoretical framework to the analysis.
Results: Participants reported ethical tensions related to resource constraints and systemic issues that precluded the provision of client-centred care. Tensions arose as therapists attempted to balance client priorities with those of the healthcare service in which they practised. Following the mandate of providing client-centred care, which involved being ‘attentive’ to clients’ needs, ‘competent’ and ‘responsible’ (Tronto, 1993), therapists were restricted by systemic constraints that did not enable them to practise in ways that addressed clients’ needs, thus setting up situations of ethical tension and distress.
Conclusion: This research provides empirical evidence of ethical tensions related to systemic constraints and resource issues in practice environments.
Implications for Practice: The research sets the stage for important discussions exploring the cost of such tensions for healthcare systems, patients and healthcare professionals.