Occupational Therapy In Health Care, 28(2):163–168, 2014 C 2014 by Informa Healthcare USA, Inc. Available online at http://informahealthcare.com/othc DOI: 10.3109/07380577.2014.903356
ARTICLE
Consensus Statements on Occupational Therapy Ethics Related to Driving Deborah Yarett Slater AOTA, Ethics Program Manager, Bethesda, Maryland, USA
ABSTRACT. As part of an expert panel convened to examine evidence and practice related to diverse aspects of driving evaluation and rehabilitation, consensus statements were developed on ethics. This paper provides context for the ethical obligation of practitioners to assess and make recommendations about the ability of clients to safely perform the activity of driving. It highlights key articles from the literature as well as principles from the Occupational Therapy Code of Ethics and Ethics Standards (2010). The statements support the importance of identifying impairments affecting driving, which could result in harm to the client as well as to the public. The ethical and professional obligation of practitioners to evaluate, make recommendations, and possibly report and/or refer to a driver rehabilitation specialist for further services is reinforced. KEYWORDS. ing
Code of ethics, driving, ethical principles, ethics, impairment, report-
BACKGROUND Occupational therapy practitioners have ethical, legal, and professional obligations to evaluate and address the issues necessary to meet client needs related to driving and community mobility. Ethical responsibilities are specifically addressed in the key ethics document of the profession, the Occupational Therapy Code of Ethics and Ethics Standards (2010) (AOTA, 2010). Other professional responsibilities are outlined in official documents of the American Occupational Therapy Association (AOTA) such as the Occupational Therapy Practice Framework: Domain and Process (AOTA, 2014) and the position statement paper entitled Driving and Community Mobility (AOTA, 2010). Legal responsibilities appear in rules and regulations of individual states and federal government regarding driving vehicles and use of transportation systems. Community mobility is considered to be an instrumental activity of daily living (IADL) with driving as a means of community mobility. Such activities support daily life within the home and community and often require complex and Address correspondence to: Ms Deborah Yarett Slater, MS, OT/L, FAOTA, Professional Affairs, AOTA, 4720 Montgomery Lane, Bethesda, MD 20814, USA. (Email: [email protected]). (Received 20 December 2013; accepted 6 March 2014)
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potentially risky interactions with the physical and social environment. In addition, IADLs are often engaged in for a major part of an individual’s lifespan. The demographics show significant growth in the older population due to Baby Boomers turning 65. These individuals often remain active and want to continue to pursue their work and life activities with the independence that may include driving or using other transportation. Therefore, two factors emerge: Increased need for risk assessment of driving as an occupation and an increased number of older clients to be served. These factors reinforce the importance and responsibility of occupational therapists to consistently ask clients questions regarding the role of driving as a desired and important occupation in the person’s daily life. Occupational therapy services address performance skills and reduction of barriers to participation in necessary or desired daily occupations. Driving performance and participation in community mobility are among the goals of services provided by occupational therapy practitioners. Ensuring safe performance of this complex IADL, making recommendations for safe utilization of alternative transportation methods if needed, advising/addressing preparation for driving retirement and/or warning about potential harm in this area are ethical obligations. In order to address these ethical (as well as legal and professional) responsibilities, and guide practice, a series of consensus statements were developed to serve as an important resource for the profession. Evidence from the Literature Literature related to the ethical, professional, and legal issues concerned with driving and community mobility primarily addresses the impact of impaired cognition on safety and the potential for harm. These findings correlate with the duty to warn (the patient/client, family, caregiver, and other relevant agencies as appropriate) where there is likelihood of foreseeable harm, to either the individual patient/client or the public (community). Judgment about foreseeable harm should be based on professional training and societal expectations. As stated in Love et al., (2008, p. 538; California Civil Code §§1708, 1714 (2004), “The duty to protect foreseeable victims from harm is a fundamental obligation of medical professionals to society.” The challenge for professionals is to gauge potential risk that may result from impairment and to weigh the impact on their own client versus society at large. This is particularly relevant when applied to the IADL of driving as impairment can have serious consequences for both the client and the public. Evidence in the literature is also important to consider in making a decision about warning and other action related to risk. Impaired cognition has been shown to increase difficulty and risk for driving (Carr, 1997; Dubinsky, Stein, & Lyons, 2000; Love, Welsh, Knabb, Scott, & Brokaw, 2008, p. 536). Safety recommendations for driving are no different than the ethical obligation to warn about safety concerns related to ADLs and other IADLs, if not more so because of the possible implications for the public (i.e., a motor vehicle crash involving others). Case law also considers that continuing to drive when warned of impairment could be interpreted as a form of communication about intent to harm from a client and, therefore, outside the privileged environment that requires confidentiality by the health care professional, further supporting the obligation to warn (Love et al, 2008, p. 541). The ethical practitioner considers the greatest good for greatest
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number of people and tries to balance potential risk to and by the impaired driver with the realistic concerns of society while maintaining a commitment to the health and privacy of the patient. Clinical Judgment and Client Values Related To Consensus Statement Occupational therapy practitioners, even without advanced or specialized skills related to driving rehabilitation, have relevant knowledge and skills and should expect to address fitness to drive at some level during the evaluation process if driving is an IADL meaningful to the client. This should happen at the appropriate time along the continuum of care, building on the strength of occupational therapy in anticipating and making recommendations not only for current services but also for those that may be required in the future. Thus, even generalist occupational therapists who evaluate clients for whom driving is a desired and/or needed activity have the expertise to make preliminary recommendations about fitness to drive and should do so to meet ethical standards of practice. This should happen within the level of their competency (Principle 1E, Code and Ethics Standards) with referral when needed for more specialized services (Principle 1I, Code and Ethics Standards, AOTA, 2010). Evaluation findings of limited range of motion, visual, perceptual, and particularly cognitive deficits may be a red flag that driving may be unrealistic without modifications or further evaluation. The overarching consideration must be, as with all occupational therapy services, client well being. Specifically, Principle 1 (beneficence) is central to all care to ensure that clients can perform meaningful activities safely or are warned about limitations for their own benefit. Likewise, the corollary, Principle 2 (nonmaleficence) “includes an obligation to not impose risks of harm, even if the potential risk is without malicious or harmful intent” (p. S19, Code and Ethics Standards, AOTA. 2010). For clients with an overriding desire for independence to meet community mobility needs, the recommendation by an occupational therapist to alter or cease driving may be ignored or disregarded, resulting in continuation of driving despite impairment. A challenge for practitioners is when the client demonstrates diminished but fluctuating cognition, which impacts client competency and the ability of the therapist to make accurate recommendations related to driving. However, that does not preclude recommendations made in good faith, with objective data based on competency and clinical reasoning. Recommendations when there is a reasonable concern about safety are even more important for driving than for other general ADLs/IADLs. This is because the potential for harm is so high, not only to clients themselves but to others who may be innocent victims. Occupational therapy practitioners can fulfill their ethical obligation to advocate for meeting client needs by considering alternative mobility strategies. These strategies will allow clients to participate in community leisure activities, IADLs, and work when returning to driving is not a viable option. Further, reimbursement concerns should not preclude or supersede appropriate recommendations about driving and community mobility based on clinical judgment. Finally, practitioners should seriously consider whether reporting an impaired client to appropriate agencies without his/her consent is required by law and/or by ethical obligation. Confidentiality requirements in the Code and Ethics Standards may be overridden by the caveat in Principle 3G which makes an exception
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for situations where a practitioner believes that a person is in serious foreseeable or imminent harm. Further, Principle 1M of the Code and Ethics Standards mandates that practitioners “report any acts that appear unethical or illegal,” thereby giving them the responsibility to know the laws in their state regarding reporting impairment related to driving. Reporting, or for occupational therapy, at least documenting and sharing recommendations with the client and other key individuals is a professional obligation for those in the role of “guardians” of the public safety as noted in an article in the Journal of Safety Research, 39, 535–545 (Love et al., 2008, p. 537). Since prevention of harm is a key principle (Principle 2-Nonmaleficence) in the Code and Ethics Standards, this is a reasonable extrapolation. Although occupational therapists do not have the authority to remove a license, they do have the ethical responsibility to share clinical findings that relate to impairment and safety, both for the client and the larger public. Consensus Statements on Ethics The consensus statements on ethics in this section were developed to reflect the professional responsibilities and client-centered approach that is central to the ethical, legal, and professional practice of occupational therapy. The statements were developed, discussed, and agreed upon by the expert group involved in the Gaps and Pathway Project (see Dickerson & Schold Davis in this issue). The statements reflect not only language in the Code and Ethics Standards but also the philosophy of the profession and content that relates to driving in these official AOTA documents: Standards of Practice for Occupational Therapy, Scope of Practice, the Occupational Therapy Practice Framework: Domain and Process and Standards for Continuing Competency. The consensus statements are organized into categories that generally reflect ethics, professional responsibility and legal rules/regulations. Ethics
• Current, appropriate evaluation and assessment tools targeted to obtain meaningful data must be used and administered correctly (Principles 1B and 1D). • Occupational therapists and occupational therapy assistants have an obligation to work within their level of competence (Principle 1E, Code and Ethics Standards): Generalist occupational therapists are qualified to obtain basic data which is relevant to driving and should be familiar with appropriate referral sources for more specialized evaluation (Principle 1I). Avoiding Harm
• Principles in the Occupational Therapy Code of Ethics and Ethics Standards (2010) support the overarching ethical obligation to provide services to benefit clients and avoid harm. Driving is an important occupation but also has potential for harm to clients as well as general public and must be considered by the practitioners. • Impaired cognition has been shown in the literature to increase difficulty and risk for driving (Carr, 1997; Dubinsky, Stein, & Lyons, 2000; Love, Welsh, Knabb, Scott, & Brokaw, 2008, p. 536). Impaired cognition also has safety implications for ADLs and IADLs. The challenge is gauging the potential risk that
Consensus Statements on OT Ethics Related to Driving
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may result from the level of impairment and requires data, professional training and professional judgment. • Case law exists and sets precedent for professional obligation to warn based on foreseeable likelihood of danger or harm due to impaired client (Tarasoff v. Regents of the University of California, 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976). • Confidentiality is presumed in client/therapist relationships but there are legal and ethical considerations that supersede this principle and should lead to communication and documentation of recommendations and possible reporting. Protection of potential victim(s) may override confidentiality rights of client. Professional
• Occupational therapy evaluation identifies deficits in performance skills (and source, e.g., client factors) that affects the ability to do daily activities (occupations). Driving is a daily occupation for a significant number of individuals across the entire lifespan. • The Occupational Profile (focused interview) should be part of the evaluation process and include/address driving if identified by client as a desired outcome. • Educational curricula prepare occupational therapists to assess impairment and safety issues with performance of daily occupations from a musculoskeletal, sensory perceptual, cognitive, and psychosocial perspective. • Driving is a high volume, high-risk activity, and the changing demographics will result in increasing demand and opportunity for occupational therapy evaluation and recommendations. • Data from occupational therapy evaluation and intervention identifies safety issues (requiring the therapist to address/document/make recommendations) related to ADLs and IADLs (e.g., bath transfers, and meal prep): A client’s performance abilities/disabilities may impact ability to drive safely, if at all. Therefore, there is a professional and ethical obligation to identify and warn when safety deficits are identified, including driving. • Professional, clinical, and ethical reasoning are taught in occupational therapy educational programs and utilized in the clinic to evaluate data and make judgments about realistic, appropriate goals, and strategies (or alternate options) to achieve them. This includes driving and community mobility. Legal
• Reimbursement should not drive decision-making related to providing driving services. (Also an ethical responsibility.) • Occupational therapy practitioners have an ethical and legal responsibility to know the laws in their state that relate to their reporting obligations and options with impaired drivers.
CONCLUSION A series of consensus statements on ethics were developed to provide a foundation for occupational therapy practitioners to address the IADL of driving. The
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statements are based on educational competency, the application of clinical judgment, ethical Principles from the Occupational Therapy Code of Ethics and Ethics Standards, and professional standards and are ethical and professional responsibilities for all occupational therapy practitioners. The consensus statements are also supported by evidence in the literature that reinforces the importance of making recommendations and reporting where impairment is identified and can lead to harm. Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper. ABOUT THE AUTHOR Ms. Deborah Yarett Slater, MS, OT/L, FAOTA, Professional Affairs, AOTA, 4720 Montgomery Lane, Bethesda, MD 20814, USA. E-mail: [email protected] REFERENCES American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006 American Occupational Therapy Association. (2010a). Occupational therapy code of ethics and ethics standards (2010). American Journal of Occupational Therapy, 64(Suppl.), S17–S26. http://dx.doi.org/10.5014/ajot.2010.64S17 American Occupational Therapy Association. (2010). Statement: Driving and community mobility statement. American Journal of Occupational Therapy, 64(Suppl.), S112–S124. Carr DB. (1997). Motor vehicle crashes and drivers with DAT. Alzheimer Disease and Associated Disorders, 11(Suppl.), 38–41. Dubinsky RM, Stein AC, & Lyons K. (2000). Practice parameter: Risk of driving and Alzheimer’s disease (an evidence-based review)—Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 54, 2205–2211. Love, C., Welsh, R., Knabb J, Scott S, & Brokaw D. (2008). Working with cognitively impaired drivers: Legal issues for mental health professionals to consider. Journal of Safety Research, 39, 535–545. Tarasoff v. Regents of the University of California, 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976).
Copyright of Occupational Therapy in Health Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
ARTICLE
Consensus Statements on Occupational Therapy Ethics Related to Driving Deborah Yarett Slater AOTA, Ethics Program Manager, Bethesda, Maryland, USA
ABSTRACT. As part of an expert panel convened to examine evidence and practice related to diverse aspects of driving evaluation and rehabilitation, consensus statements were developed on ethics. This paper provides context for the ethical obligation of practitioners to assess and make recommendations about the ability of clients to safely perform the activity of driving. It highlights key articles from the literature as well as principles from the Occupational Therapy Code of Ethics and Ethics Standards (2010). The statements support the importance of identifying impairments affecting driving, which could result in harm to the client as well as to the public. The ethical and professional obligation of practitioners to evaluate, make recommendations, and possibly report and/or refer to a driver rehabilitation specialist for further services is reinforced. KEYWORDS. ing
Code of ethics, driving, ethical principles, ethics, impairment, report-
BACKGROUND Occupational therapy practitioners have ethical, legal, and professional obligations to evaluate and address the issues necessary to meet client needs related to driving and community mobility. Ethical responsibilities are specifically addressed in the key ethics document of the profession, the Occupational Therapy Code of Ethics and Ethics Standards (2010) (AOTA, 2010). Other professional responsibilities are outlined in official documents of the American Occupational Therapy Association (AOTA) such as the Occupational Therapy Practice Framework: Domain and Process (AOTA, 2014) and the position statement paper entitled Driving and Community Mobility (AOTA, 2010). Legal responsibilities appear in rules and regulations of individual states and federal government regarding driving vehicles and use of transportation systems. Community mobility is considered to be an instrumental activity of daily living (IADL) with driving as a means of community mobility. Such activities support daily life within the home and community and often require complex and Address correspondence to: Ms Deborah Yarett Slater, MS, OT/L, FAOTA, Professional Affairs, AOTA, 4720 Montgomery Lane, Bethesda, MD 20814, USA. (Email: [email protected]). (Received 20 December 2013; accepted 6 March 2014)
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potentially risky interactions with the physical and social environment. In addition, IADLs are often engaged in for a major part of an individual’s lifespan. The demographics show significant growth in the older population due to Baby Boomers turning 65. These individuals often remain active and want to continue to pursue their work and life activities with the independence that may include driving or using other transportation. Therefore, two factors emerge: Increased need for risk assessment of driving as an occupation and an increased number of older clients to be served. These factors reinforce the importance and responsibility of occupational therapists to consistently ask clients questions regarding the role of driving as a desired and important occupation in the person’s daily life. Occupational therapy services address performance skills and reduction of barriers to participation in necessary or desired daily occupations. Driving performance and participation in community mobility are among the goals of services provided by occupational therapy practitioners. Ensuring safe performance of this complex IADL, making recommendations for safe utilization of alternative transportation methods if needed, advising/addressing preparation for driving retirement and/or warning about potential harm in this area are ethical obligations. In order to address these ethical (as well as legal and professional) responsibilities, and guide practice, a series of consensus statements were developed to serve as an important resource for the profession. Evidence from the Literature Literature related to the ethical, professional, and legal issues concerned with driving and community mobility primarily addresses the impact of impaired cognition on safety and the potential for harm. These findings correlate with the duty to warn (the patient/client, family, caregiver, and other relevant agencies as appropriate) where there is likelihood of foreseeable harm, to either the individual patient/client or the public (community). Judgment about foreseeable harm should be based on professional training and societal expectations. As stated in Love et al., (2008, p. 538; California Civil Code §§1708, 1714 (2004), “The duty to protect foreseeable victims from harm is a fundamental obligation of medical professionals to society.” The challenge for professionals is to gauge potential risk that may result from impairment and to weigh the impact on their own client versus society at large. This is particularly relevant when applied to the IADL of driving as impairment can have serious consequences for both the client and the public. Evidence in the literature is also important to consider in making a decision about warning and other action related to risk. Impaired cognition has been shown to increase difficulty and risk for driving (Carr, 1997; Dubinsky, Stein, & Lyons, 2000; Love, Welsh, Knabb, Scott, & Brokaw, 2008, p. 536). Safety recommendations for driving are no different than the ethical obligation to warn about safety concerns related to ADLs and other IADLs, if not more so because of the possible implications for the public (i.e., a motor vehicle crash involving others). Case law also considers that continuing to drive when warned of impairment could be interpreted as a form of communication about intent to harm from a client and, therefore, outside the privileged environment that requires confidentiality by the health care professional, further supporting the obligation to warn (Love et al, 2008, p. 541). The ethical practitioner considers the greatest good for greatest
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number of people and tries to balance potential risk to and by the impaired driver with the realistic concerns of society while maintaining a commitment to the health and privacy of the patient. Clinical Judgment and Client Values Related To Consensus Statement Occupational therapy practitioners, even without advanced or specialized skills related to driving rehabilitation, have relevant knowledge and skills and should expect to address fitness to drive at some level during the evaluation process if driving is an IADL meaningful to the client. This should happen at the appropriate time along the continuum of care, building on the strength of occupational therapy in anticipating and making recommendations not only for current services but also for those that may be required in the future. Thus, even generalist occupational therapists who evaluate clients for whom driving is a desired and/or needed activity have the expertise to make preliminary recommendations about fitness to drive and should do so to meet ethical standards of practice. This should happen within the level of their competency (Principle 1E, Code and Ethics Standards) with referral when needed for more specialized services (Principle 1I, Code and Ethics Standards, AOTA, 2010). Evaluation findings of limited range of motion, visual, perceptual, and particularly cognitive deficits may be a red flag that driving may be unrealistic without modifications or further evaluation. The overarching consideration must be, as with all occupational therapy services, client well being. Specifically, Principle 1 (beneficence) is central to all care to ensure that clients can perform meaningful activities safely or are warned about limitations for their own benefit. Likewise, the corollary, Principle 2 (nonmaleficence) “includes an obligation to not impose risks of harm, even if the potential risk is without malicious or harmful intent” (p. S19, Code and Ethics Standards, AOTA. 2010). For clients with an overriding desire for independence to meet community mobility needs, the recommendation by an occupational therapist to alter or cease driving may be ignored or disregarded, resulting in continuation of driving despite impairment. A challenge for practitioners is when the client demonstrates diminished but fluctuating cognition, which impacts client competency and the ability of the therapist to make accurate recommendations related to driving. However, that does not preclude recommendations made in good faith, with objective data based on competency and clinical reasoning. Recommendations when there is a reasonable concern about safety are even more important for driving than for other general ADLs/IADLs. This is because the potential for harm is so high, not only to clients themselves but to others who may be innocent victims. Occupational therapy practitioners can fulfill their ethical obligation to advocate for meeting client needs by considering alternative mobility strategies. These strategies will allow clients to participate in community leisure activities, IADLs, and work when returning to driving is not a viable option. Further, reimbursement concerns should not preclude or supersede appropriate recommendations about driving and community mobility based on clinical judgment. Finally, practitioners should seriously consider whether reporting an impaired client to appropriate agencies without his/her consent is required by law and/or by ethical obligation. Confidentiality requirements in the Code and Ethics Standards may be overridden by the caveat in Principle 3G which makes an exception
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for situations where a practitioner believes that a person is in serious foreseeable or imminent harm. Further, Principle 1M of the Code and Ethics Standards mandates that practitioners “report any acts that appear unethical or illegal,” thereby giving them the responsibility to know the laws in their state regarding reporting impairment related to driving. Reporting, or for occupational therapy, at least documenting and sharing recommendations with the client and other key individuals is a professional obligation for those in the role of “guardians” of the public safety as noted in an article in the Journal of Safety Research, 39, 535–545 (Love et al., 2008, p. 537). Since prevention of harm is a key principle (Principle 2-Nonmaleficence) in the Code and Ethics Standards, this is a reasonable extrapolation. Although occupational therapists do not have the authority to remove a license, they do have the ethical responsibility to share clinical findings that relate to impairment and safety, both for the client and the larger public. Consensus Statements on Ethics The consensus statements on ethics in this section were developed to reflect the professional responsibilities and client-centered approach that is central to the ethical, legal, and professional practice of occupational therapy. The statements were developed, discussed, and agreed upon by the expert group involved in the Gaps and Pathway Project (see Dickerson & Schold Davis in this issue). The statements reflect not only language in the Code and Ethics Standards but also the philosophy of the profession and content that relates to driving in these official AOTA documents: Standards of Practice for Occupational Therapy, Scope of Practice, the Occupational Therapy Practice Framework: Domain and Process and Standards for Continuing Competency. The consensus statements are organized into categories that generally reflect ethics, professional responsibility and legal rules/regulations. Ethics
• Current, appropriate evaluation and assessment tools targeted to obtain meaningful data must be used and administered correctly (Principles 1B and 1D). • Occupational therapists and occupational therapy assistants have an obligation to work within their level of competence (Principle 1E, Code and Ethics Standards): Generalist occupational therapists are qualified to obtain basic data which is relevant to driving and should be familiar with appropriate referral sources for more specialized evaluation (Principle 1I). Avoiding Harm
• Principles in the Occupational Therapy Code of Ethics and Ethics Standards (2010) support the overarching ethical obligation to provide services to benefit clients and avoid harm. Driving is an important occupation but also has potential for harm to clients as well as general public and must be considered by the practitioners. • Impaired cognition has been shown in the literature to increase difficulty and risk for driving (Carr, 1997; Dubinsky, Stein, & Lyons, 2000; Love, Welsh, Knabb, Scott, & Brokaw, 2008, p. 536). Impaired cognition also has safety implications for ADLs and IADLs. The challenge is gauging the potential risk that
Consensus Statements on OT Ethics Related to Driving
167
may result from the level of impairment and requires data, professional training and professional judgment. • Case law exists and sets precedent for professional obligation to warn based on foreseeable likelihood of danger or harm due to impaired client (Tarasoff v. Regents of the University of California, 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976). • Confidentiality is presumed in client/therapist relationships but there are legal and ethical considerations that supersede this principle and should lead to communication and documentation of recommendations and possible reporting. Protection of potential victim(s) may override confidentiality rights of client. Professional
• Occupational therapy evaluation identifies deficits in performance skills (and source, e.g., client factors) that affects the ability to do daily activities (occupations). Driving is a daily occupation for a significant number of individuals across the entire lifespan. • The Occupational Profile (focused interview) should be part of the evaluation process and include/address driving if identified by client as a desired outcome. • Educational curricula prepare occupational therapists to assess impairment and safety issues with performance of daily occupations from a musculoskeletal, sensory perceptual, cognitive, and psychosocial perspective. • Driving is a high volume, high-risk activity, and the changing demographics will result in increasing demand and opportunity for occupational therapy evaluation and recommendations. • Data from occupational therapy evaluation and intervention identifies safety issues (requiring the therapist to address/document/make recommendations) related to ADLs and IADLs (e.g., bath transfers, and meal prep): A client’s performance abilities/disabilities may impact ability to drive safely, if at all. Therefore, there is a professional and ethical obligation to identify and warn when safety deficits are identified, including driving. • Professional, clinical, and ethical reasoning are taught in occupational therapy educational programs and utilized in the clinic to evaluate data and make judgments about realistic, appropriate goals, and strategies (or alternate options) to achieve them. This includes driving and community mobility. Legal
• Reimbursement should not drive decision-making related to providing driving services. (Also an ethical responsibility.) • Occupational therapy practitioners have an ethical and legal responsibility to know the laws in their state that relate to their reporting obligations and options with impaired drivers.
CONCLUSION A series of consensus statements on ethics were developed to provide a foundation for occupational therapy practitioners to address the IADL of driving. The
168
Slater
statements are based on educational competency, the application of clinical judgment, ethical Principles from the Occupational Therapy Code of Ethics and Ethics Standards, and professional standards and are ethical and professional responsibilities for all occupational therapy practitioners. The consensus statements are also supported by evidence in the literature that reinforces the importance of making recommendations and reporting where impairment is identified and can lead to harm. Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper. ABOUT THE AUTHOR Ms. Deborah Yarett Slater, MS, OT/L, FAOTA, Professional Affairs, AOTA, 4720 Montgomery Lane, Bethesda, MD 20814, USA. E-mail: [email protected] REFERENCES American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006 American Occupational Therapy Association. (2010a). Occupational therapy code of ethics and ethics standards (2010). American Journal of Occupational Therapy, 64(Suppl.), S17–S26. http://dx.doi.org/10.5014/ajot.2010.64S17 American Occupational Therapy Association. (2010). Statement: Driving and community mobility statement. American Journal of Occupational Therapy, 64(Suppl.), S112–S124. Carr DB. (1997). Motor vehicle crashes and drivers with DAT. Alzheimer Disease and Associated Disorders, 11(Suppl.), 38–41. Dubinsky RM, Stein AC, & Lyons K. (2000). Practice parameter: Risk of driving and Alzheimer’s disease (an evidence-based review)—Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 54, 2205–2211. Love, C., Welsh, R., Knabb J, Scott S, & Brokaw D. (2008). Working with cognitively impaired drivers: Legal issues for mental health professionals to consider. Journal of Safety Research, 39, 535–545. Tarasoff v. Regents of the University of California, 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976).
Copyright of Occupational Therapy in Health Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
