Ethical Considerations in Clinical Reasoning: The Impact of Technology and Cost Containment

Abstract

This article raises, but does not answer, the kinds of questions that need to be asked by responsible occupational therapists in the 1980s--ethical questions that deal with technological advances on the one hand and limited resources on the other. The article examines moral dilemmas that practitioners and students face when making clinical decisions in a climate where technology and cost containment may overshadow the needs of the individual patient. A review of the literature on clinical reasoning, technology, and cost containment provides the background for a discussion of specific issues of quality of life for the occupational therapist. Implications for education and practice are presented, with suggestions for further consideration.

Therapy Caps and Variation in Cost of Outpatient Occupational Therapy by Provider, Insurance Status, and Geographic Region

“…In our hypothetical scenarios, a large difference existed between the cost of coinsurance and the overall price, which likely represented the financial liability for someone who was uninsured. These cost differences could potentially lead to patients receiving a less-than-optimal amount of care (Landry et al, 2006;Neuhaus, 1988).…”

“…Neuhaus (1988) called for "considerable attention" to the ethical ramifications of the cost of health care, asking, "Who is to pay for costs incurred, and what regulator guidelines are necessary?" (p. 292).…”

Clinical Reasoning in Community Occupational Therapy

“…Contextual aspects of clinical reasoning are exemplified in intersubjective and interpersonal theories (Crepeau, 1991;Lloyd and Maas, 1992), which inform the therapeutic relationship between the client and the clinician. Contextual aspects of clinical reasoning are also to be found in moral and ethical imperatives, such as quality of life issues (Graner, 1989) and cost containment (Neuhaus, 1988). Indeed, the literature demonstrates that the altruistic, client-eentred thinking inherent in clinical practice must be tempered by the reality of the clinical context.…”

Values Influencing Clinical Reasoning in Occupational Therapy: An Exploratory Study

“…C linical reasoning, essentially a decision-making process, is receiving' increasing attention in the literature (Gilkeson & Hanten, 1984;Gillette & Mattingly, 1987;Neuhaus, 1988). This process is directed to a specific, practical end-a right action for a particular patient, given that person's situation at the time of the decision (Pellegrino & Thomasma, 1981).…”