Doing what’s right: A grounded theory of ethical decision-making in occupational therapy

Abstract

Background: Ethical decision-making is an important aspect of reasoning in occupational therapy practice. However, the process of ethical decision-making within the broader context of reasoning is yet to be clearly explicated.

Objective: The purpose of this study was to advance a theoretical understanding of the process by which occupational therapists make ethical decisions in day-to-day practice.

Method: A constructivist grounded theory approach was adopted, incorporating in-depth semi-structured interviews with 18 occupational therapists from a range of practice settings and years of experience. Initially, participants nominated as key informants who were able to reflect on their decision-making processes were recruited. Theoretical sampling informed subsequent stages of data collection. Participants were asked to describe their process of ethical decision-making using scenarios from clinical practice. Interview transcripts were analyzed using a systematic process of initial then focused coding, and theoretical categorization to construct a theory regarding the process of ethical decision-making.

Findings: An ethical decision-making prism was developed to capture three main processes: Considering the Fundamental Checklist, Consulting Others, and Doing What’s Right. Ethical decision-making appeared to be an inductive and dialectical process with the occupational therapist at its core.

Conclusion: Study findings advance our understanding of ethical decision-making in day-to-day clinical practice.

Keywords:

• Clinical decision-making
• ethics
• professional practice
• qualitative research
• rehabilitation research

Acknowledgements

The authors would like to thank the occupational therapists who gave of their time to participate in this study and who so generously shared their perspectives and clinical experiences. We also gratefully acknowledge Dr. Joyce Tryssenaar for her valuable contribution to planning this study and to Jennifer Schmaltz of Jen Schmaltz Boutique Design Studio for her assistance with graphic design.

Disclosure statement

No potential conflict of interest was reported by the authors.

Disclaimer

The views expressed in the submitted manuscript are those of the authors and not an official position of the institution or funder.

Additional information

Funding

This work was supported by the McMaster Legacy Fund Grant awarded by the Canadian Occupational Therapy Foundation.