A More Complete Approach to Thinking about Ethics

          One of the recent trends in ethical thinking is to label any kind of caring behavior or attitude as social justice. This trend has also manifested itself in occupational therapy. One of the consequences of this is the practice of calling those who oppose social justice uncaring. This is common in the debate over the social justice requirement in the AOTA Code of Ethics. There have been comments like the following:

          "Of course I'm for social justice. Why would I be in favor of social injustice?"

          This singular focus on social justice in discussing caring behaviors reflects an incomplete approach to thinking about ethics. It is based on overlooking two important issues. One is that in the academic literature social justice is chiefly a political term, something that is true generally and also true specifically within the field of occupational therapy. The meaning of “political” here refers to involvement in government policies. The second overlooked issue is that there are other ethical principles at play in attitudes and behaviors that involve helping others. A more complete approach to ethical thinking would account for these issues.

          It should be noted that the earliest recorded use of the term social justice only came in the 1800s, less than 200 years ago. But people have been helping those in need for several thousand years before that. In the Western world, one of the sets of values promoting the idea of helping others was known as The Acts of Mercy, from the Catholic tradition. Part of this was taking care of the material needs of others, such as food and shelter. Another concept with both religious and secular significance is charity. In secular terms, charity is a voluntary act used to help others in need. In religious terms, it involves a duty to do so. The blanket use of the term social justice for of all of these behaviors and attitudes obscures these ideas. This blanket use also obscures the distinction between individual voluntary help on one hand with the idea of using the coercive powers of government to achieve those ends on the other.

          Because we already have words such as charity to describe the idea of helping others, there is no need for the verbal inflation “social justice” to describe it. This is the crux of the problem in social justice disputes over whether someone is caring or not. Those who say they are opposed to social justice are never opposed to people voluntarily helping others. What they oppose is the idea of the government agenda often entailed in the use of the term.

          Within health care ethics specifically, there are already other principles referring to attitudes and behaviors dealing with helping others. The Principle of Nonmaleficence in the 2010 AOTA Code of Ethics, for example, requires therapists to make efforts to ensure continuity of care. The Principle of Autonomy requires that therapists establish collaborative relationships with patients and work to achieve their goals for therapy. The Principle of Procedural Justice requires unbiased decision-making and working to prevent discrimination. The most robust principle when it comes to helping others is The Principle of Beneficence. As stated in the Code of Ethics:

          “Beneficence includes all forms of action intended to benefit other persons.”

         The Code also states that Beneficence is about “mercy, kindness, and charity.” Mercy is about having compassion for the suffering of others – recall the Acts of Mercy. And charity refers specifically to providing help to those in need. The Principle of Beneficence in the 2010 Code also includes the following:

·         Promoting good

·         Preventing harm

·         Helping persons with disabilities

·         Rescuing persons in danger

·         Protecting and defending the rights of others 

·         Notifying the appropriate authorities about illegal or unethical conduct

         The 2005 Code of Ethics also listed the following under the Principe of Beneficence:

·         Provide services in a fair and equitable manner.

·         Being sensitive to issues of race, ethnicity, sexual orientation, and gender identity

                                ·       Promoting health and safety 

          A more complete approach to thinking about ethics will take notice of all the other ethical principles involved in the idea of helping others. It would particularly take note of the robust nature of Beneficence. And, as an ultimate point on clarity, such thinking will also attempt to identify whether a discussion is addressing individual voluntary actions intended to help others or government policies intended to do so.

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