An Analysis of AOTA's Advisory Opinion on Social Justice
In 2010 the AOTA Ethics Commission rewrote the organization’s code of ethics to include a new and controversial ethical requirement, social justice. In that same year, the Ethics Commission published a document that is commonly known as the “Advisory Opinion on Social Justice,” although its official title is “Social Justice and Meeting the Needs of Clients.” It can be found here: http://www.aota.org/Practitioners/Ethics/Advisory/Social-Justice.aspx.
An “advisory opinion” is a paper issued by an organization in order to explain one of the organization’s rules. An advisory opinion offers guidance on the application of a rule. Because the social justice requirement was a new rule for the AOTA Code of Ethics, it made sense for the Ethics Commission to issue an advisory opinion so that practitioners could learn how to apply the rule to concrete situations. (Note: the AOTA Code of Ethics will occasionally be referred to below as simply the Code).
One of the major events that followed the enactment of the new Code of Ethics was that three AOTA members, Kathy Grace, Claudette Reid and Dr. DiZazzo-Miller, filed a motion to remove the social justice requirement. As part of their motion, Grace et al. wrote that the social justice requirement “is politically charged,” thus “Bringing politics into a code of ethics [and] offend[ing] those [with] differing views and facilitate[ing] division” (see “Supporting Document”). In other words, Grace et al. were trying to keep the integrity of the Code of Ethics, which promotes the values of inclusion and diversity. The politically divisive social justice requirement robs the Code of Ethics of integrity precisely on the issue of inclusion regarding those with diverse political and philosophical perspectives.
As part of their argument, Grace et al. criticized the advisory opinion on social justice. They reviewed the advisory opinion to see if it could justify the social justice requirement. They concluded that “AOTA’s Advisory Opinion on Social Justice does not articulate nor validate the inclusion of the concept of social justice . . . in our Code of Ethics [because all of the] scenarios in this document are resolved using other principles” (see motion by Grace et. al). In other words, they concluded that there was no justification for the social justice requirement in the Code of Ethics.
In contrast to this point of view, is the statement by Dr. Brent Braveman, who was one of the co-editors of the 2009 special social justice edition of the American Journal of Occupational Therapy. Of Grace et al.’s conclusion regarding the advisory opinion, Dr. Braveman wrote:
“Contrary to the rationale presented by the Authors of Motions 2, AOTA’s Advisory Opinion on Social Justice does articulate and validates the inclusion of the concept of social justice in our Code of Ethics” (see http://otconnections.aota.org/community_blogs/b/brentbraveman/archive/2011/03/24/an-open-letter-to-members-of-the-representative-assembly-and-aota-members-on-motion-2-for-the-spring-ra.aspx , accessed July 7, 2013).
Neither Grace et al. nor Dr. Braveman provided a detailed analysis of the advisory opinion to substantiate their positions. That is the purpose of this post.
Before we begin, I would like to orient the reader in the broadest terms to the structure of the 2010 AOTA Code of Ethics. At its core are seven principles that are numbered 1-7. The social justice requirement is formally known as “Principle 4.” In addition to a title and subtitle, each principle is divided into two main parts. The first part explains the principle. The second part contains subsections listed in alphabetical order. These subsections are generally meant to be the practical application of the principle. (Principle 4 has seven subsections and they are titled A-G. See 2010 Code of Ethics here: http://www.aota.org/Consumers/Ethics/39880.aspx). The seven principles of the Code of Ethics are:
1. Beneficence
2. Non-malfeasance
3. Autonomy and Confidentiality
4. Social Justice
5. Procedural Justice
6. Veracity
7. Fidelity
Two curious facts will jump out at you as you read the advisory opinion on social justice: (1) is how often principles other than social justice are referenced in the document, and (2) is the paucity of references to Principle 4 itself. A third curious fact is how far into the document you have to read until you find a reference to Principle 4: the first reference is about two-thirds of the way into the document.
The following are the references in the advisory opinion to the various principles in the Code, in the order they appear:
Principle 1 Beneficence
Principle 5 Procedural Justice
Principle 1 Beneficence Subsection C
Principle 1 Beneficence Subsection H
Principle 6 Veracity Subsection C
Principle 6 Veracity Subsection B
Principle 6 Veracity Subsection C
Principle 6 Veracity Subsection D
Principle 7 Fidelity Subsection H
Principle 4 Social Justice Subsection G
Principle 4 Social Justice Subsection E
Principle 4 Social Justice Subsection E
This list shows that there were 12 references to the principles and some of their subsections. Only 3 of these references, that is 25% of them, are to the social justice principle, Principle 4. That already is a problem. If you are introducing a new and controversial requirement into the Code of Ethics and your references to it in the advisory opinion constitute only 25% of the total references to the Code, something is wrong.
But even this 25% is exaggerated for a couple of reasons. One of these is that Subsection E of Principle 4 is mentioned twice. Principle 4 has seven subsections, labeled A-G, so even in the little that is mentioned, much has been left out. The second reason why this 25% is exaggerated has to do with where Subsection E came from. In order to understand the problem of where Subsection E came from, you first need to know what Subsection E says. Subsection E of Principle 4 from the 2010 Code of Ethics says that therapists are required to:
“Make efforts to advocate for recipients of occupational therapy services to obtain needed services through available means.”
Now we need to go back to the 2005 Code of Ethics and look at the Principle of Beneficence. Subsection C from the Principle of Beneficence in the 2005 Code of Ethics requires therapists to:
“Make every effort to advocate for recipients to obtain needed services through available means”
As can be readily seen, it is the same language from Principle 4 Subsection E of the 2010 Code of Ethics. Keep in mind that we are trying to see if the advisory opinion on social justice provides some justification for a new and highly controversial requirement. But what we see now is that two of the references to the requirement in the advisory opinion are nothing new. They are something old that was taken from the Principle of Beneficence in the 2005 Code of Ethics and transferred in.
Recall that Grace et al. said that one of the reasons the advisory opinion failed to justify the social justice requirement was that all the issues presented in the opinion were easily addressed by all the other principles in the Code. The fact that the Ethics Commission had to transfer subsections from other parts of the Code into the principle of social justice validates this argument.
So, instead of referencing the principle of social justice 25% of the time, the advisory opinion really references it much less than that. Once we recognize that two of those references are really to another principle that was transferred into the social justice requirement, the advisory opinion’s references to subsections of Principle 4 come down to about 8% of the total. In other words, the advisory opinion on social justice refers to principles other than social justice over 90% of the time.
And here we should use the real number rather than percentages, so as not to exaggerate the references to Principle 4 in the advisory opinion. The real number is ONE. There is only one true reference to a subsection of Principle 4 that was not taken from one of the other principles. That is Subsection G. And what does Subsection G of Principle 4 require? It requires therapists to consider working for free for some patients. That is all the new stuff we get in the advisory opinion: consider working for free.
That can hardly justify the inclusion of such a divisive and controversial requirement into the Code of Ethics. This is especially so when the idea of requiring others to work for free, even if it were legitimate, is something that could easily be put into the Principle of Beneficence. The Principle of Beneficence is explained in the 2010 Code of Ethics as referring to “kindness,” “charity,” and “helping others.” Since charity is about donating money or time, Subsection G from Principle 4 is actually redundant. This means that even that 8% number drops to 0% once you see that the ideas contained in Principle 4 Subsection G are thematically appropriately suited to ideas of charity and helping others expressed in the Principle of Beneficence.
The only logical conclusion one can draw from an analysis of the advisory opinion on social justice is that it has failed to justify the social justice requirement. Grace et al. were correct: the issues addressed in the advisory opinion are all easily resolved by using the other principles in the Code.
Comments:
add comment
