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Ethical Allocation of Resources in Provision of Occupational Therapy Services

Discussion

This case presents a common dilemma for practitioners "whose altruism is usually the primary motivating force for seeking a career in occupational therapy and whose guiding principle of ethical practice is beneficence, or 'doing good' for the recipient of service" [1, p. 49]. Often ethical dilemmas are encountered when there is conflict between the provider and patient. However, this case presents several complicating factors involving conflict emanating from the provider's and patient's relationship with the institution and third-party payer. Therefore in addition to conflicts related to the principle of beneficence, there is also discord with the ethical principles of fidelity and justice.

While conflicts related to the application of the beneficence principle permeate the clinical ethics arena, ethical dilemmas regarding fidelity and justice are especially prevalent in areas of organizational ethics.

Simply put, beneficence is the principle of taking action to impart benefit to service recipients [6].

The principle of fidelity relates to "the obligation to act in good faith to keep vows and promises, fulfill agreements, maintain relationships, and discharge fiduciary responsibilities" [6, p.312].

The principle of justice relates to "fair, equitable, and appropriate distribution" of resources [6, p. 226].

Acting in accordance with the identified ethical principles generally results in benefit to the patient. However, as noted, delivery of services in a market-based organizational structure may pit practitioners against service recipients, reimbursement agencies, other providers, and the organization itself.