Ethical Considerations Related to Evidence-Based Practice

Abstract

In this article, we have identified some of the ethical considerations related to evidence-based practice and surrounding issues as they bear on occupational therapy and rehabilitation. We acknowledge that practitioners are professionally and morally obligated to ensure that their decisions are informed and reflect best practices. Further, we recognize the value of encouraging practitioners to assume responsibility for searching and appraising available evidence so that informed options can be shared with patients. Table 1 summarizes the ethical considerations in evidence-based practice. Ethical dilemmas are a natural part of the health care enterprise. They existed before evidence-based practice became an everyday term, and they present themselves whether or not evidence-based practice is introduced into a clinical decision. From a moral and professional standpoint, the dangers of not attending to evidence are just as significant as the ethical issues attending to its application. Evidence-based practice has clear limitations in occupational therapy and rehabilitation. Currently, these limitations loom as major obstacles to practice behaviors that are better informed and influenced by research. In the United States, the implementation of a prospective payment system in rehabilitation will provide increased impetus for research and for attention to the results of that research. As we consider and apply this research to practice, we must do so judiciously, mindful that evidence-based practice is a gift that comes to health care in ethical wrappings.

Supporting, Promoting, Respecting and Advocating: A Scoping Study of Rehabilitation Professionals’ Responses to Patient Autonomy

“…The papers included in our review can be grouped into three broad categories related to autonomy: 1) principlist accounts, 2) rights-based and legal analyses, and 3) relational/social approaches; the principlist approach and its application to ethical issues in rehabilitation or to specific cases being the most frequent [14,19,25,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. A common feature of articles drawing upon principlist accounts is to discuss the principle of respect for autonomy in light of other principles, including beneficence, non-maleficence and, less frequently, justice.…”

“…The second most common category of conceptual accounts includes rights-based and legal perspectives. Major concerns addressed in articles centering on this approach include case studies related to the rights of incompetent patients, or those with diminished capacity, to make care decisions or refuse treatment [24,[60][61][62][63][64][65][66][67], and the evaluation of capacity [5,23,36,37,[68][69][70]. The third conceptual approach to autonomy emphasizes interdependence, family and social relationships, and the social and political location of the individual.…”

Clinical physical therapists research activity reality and barriers to their utilizing research findings

“…Since practical physical therapy is performed on patients in the clinical environment, significant evidence-based practice also needs to be conducted in the clinical environment. The application of evidence-based practice is an important part of clinical decision making when providing evaluation of rehabilitation and therapeutic services 9 ) .…”

Culturally responsive evidence-based special education practice: Whaia ki te ara tika

“…Increasing pressure is being asserted on government-funded sectors to provide services that draw from the most effective research, are timely, outcomes focused, and fully accountable (Hammersley, 2001). Within the Ministry of Education Special Education (SE) service, increasing onus is being placed on practitioners to be critical consumers of research; to discerningly evaluate and interpret the best available information, tempered with practitioner skill and experience (Christiansen & Lou, 2001).…”