Navigating Ethical Tensions When Working to Address Social Inequities

Abstract

Importance: When providing services, occupational therapists encounter social inequities that affect the health and well-being of their clients and create ethical tensions. Objective: To develop an understanding of the ethical tensions encountered by occupational therapists working with clients experiencing social inequity and how such tensions are navigated. Design: This qualitative study used an interpretive description methodology. Setting: Community and tertiary health settings. Participants: Fifteen occupational therapists who identified as working with clients experiencing social inequity. Outcomes and Measures: Semistructured interviews were used to explore participants' practice experiences. Data were analyzed using thematic analysis. Results: Two themes were identified in relation to participants' experiences of ethical tensions: (a) perpetuating inequities and (b) experiencing conflicting values. A further three themes were identified in relation to how participants identified and navigated these tensions: (a) taking action, (b) seeking support, and (c) ensuring integrity and accountability. Conclusions and Relevance: Ethical tensions frequently emerged when systemic health contexts were not responsive to social inequities or created barriers to health care access. Occupational therapists felt a sense of responsibility to take action to address inequity, which led them to stretch boundaries and roles. Having informal and formal supports, and confidence in the scope of their practice, helped the occupational therapists to navigate ethical tensions with integrity and accountability. Increased avenues for support that incorporate reflexivity offer an opportunity for occupational therapists to engage in dialogue about social inequities and ethical practice.