Lack of ethical reasoning in the innovation narrative of … · 2017-09-30 · innovation narrative...

Eubios Journal of Asian and International Bioethics 27 (March 2017)

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dysfunction (acute stage)). Japan Journal ofOccupationalTherapy50(1):80-4.

Hocking C, Ness NE. 2002. World Federation ofOccupationalTherapistsRevisedMinimumStandardsforthe Education of Occupational Therapists 2002, Thecouncil of the World Federation of OccupationalTherapists.

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Japanese Association of Occupational Therapists. 2010.Sagyoryoho rinshojissyu no tebiki dai4pan (Theguideline of occupational therapy clinical internship,fourth edition). http://www.jaot.or.jp/wp-content/uploads/2012/08/rinshoujisshuVer.422203251.pdf(Accessedon2016.11.14�

JapaneseAssociation ofOccupational Therapists. 2014.sagyoryohoshi kyouiku no saitei kijun kaitei dai 3 pan(theminimum standard of education for occupationaltherapist). (Accessed on 2017.1.30)http://www.jaot.or.jp/wp-content/uploads/2013/12/OTmimimumstandard-3nd1.pdf>.

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MinistryofHealth,LabourandWelfare.1999.Theguideto teaching for physical and occupational therapytraining institutions. (Accessed on 2017.1.6)https://kouseikyoku.mhlw.go.jp/kantoshinetsu/shokan/kankeihourei/documents/yoryo_rigaku.pdf>

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Lack of ethical reasoning in the innovation narrative of Occupational Therapy and Occupational Science literature

-SamanthaSirianni,CummingSchoolofMedicine,UniversityofCalgary,CalgaryT2N4N1,Alberta,CanadaEmail:smsirian@ucalgary.ca-GregorWolbringDepartmentofCommunityHealthSciences,CummingSchoolofMedicine,StreamofCommunityRehabilitationandDisabilityStudiesCummingSchoolofMedicine,TRWbuilding3D31UniversityofCalgary,3330HospitalDriveNW,Calgary,Alberta,Canada(Correspondence)Email:[email protected]

Abstract Occupational therapyandoccupationalsciencearetwofieldsthatareimpactedbyinnovationsandareseen as innovative. Ethical reasoning is seen asessential for guiding innovative processes such asthedevelopmentofnewscientificandtechnologicalproducts. At the same time it is reported thatethicists“lacktheappropriate intellectualtools forpromotingdeepmoral change inour society” andthat members of the public such as parents ofchildren with disabilities do not necessarily useethical theories and ethical reasoning to highlighttheir problems. The purpose of this study was toinvestigate how the fields of occupational therapyandoccupationalscienceengagewithethicswithintheir innovation-covering academic literature andwhether occupational therapy and occupationalsciencewerementioned in academic journals thatcontained words starting with “ethic” in the title.Wefound littleconceptualengagementwithethicsprinciplesandnoemploymentofethicaltheoriesinthe academic literature covered. We also foundlittle engagement with occupational therapy oroccupational science in academic journals that


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contained words starting with “ethic” in the title.Ourfindingsareanotherexampleofthelimiteduseof the term ethics and limited uptake of ethicalreasoning using ethical theories giving furtherweighttotheconcernsSherwinvoiced. Key words: ethics, ethical theories, ethical reasoning, innovation, science, technology, occupational therapy, occupational science; 1. Introduction Occupational therapy and occupational sciencefocus on improving the health and well-being ofpeople by enabling people to participate in theactivities of everyday life [4]. Occupationaltherapists are responsible to remain current withnew developments in the profession and tomaintain excellence in their practice [5].Occupational therapy and occupational science asfieldsandoccupational therapistsarecontinuouslyimpactedbyscientific,technologicalandinnovation(STI)developments[6].Ethical theoriesandethicalreasoning are employed with local and globalscopes when one discusses for example thegovernance of scientific, technological andinnovation(STI)developments[2,7-25].

Ethicsisaboutwhatoneoughttodo.However,as Sherwin stated, “we [ethicists] lack theappropriate intellectual tools for promoting deepmoral change in our society” ([1] quoted in[2]).Furthermore one study revealed that members ofthe public such as parents of children withdisabilities do not use ethical theories and ethicalreasoningtohighlighttheirproblems[3].Ourstudyinvestigatedhowthefieldsofoccupationaltherapyandoccupationalscienceengagewithethicswithintheir academic literature covering innovation andwhether occupational therapy and occupationalscience were mentioned in academic journalscontainingwordsstartingwith“ethic”inthetitle.1.1. Occupational Therapy and Occupational Science AccordingtotheWorldFederationofOccupationalTherapy, “Occupational therapy is the art andscienceofenablingengagement ineveryday living,throughoccupation;ofenablingpeople toperformthe occupations that foster health and well-being;andofenablinga justand inclusivesocietyso thatall peoplemayparticipate to theirpotential in thedailyoccupationsoflife”[4].

Occupational therapistsworkwithpeopleandcommunities “toenhance theirability toengage inthe occupations they want to, need to, or areexpected to do, or bymodifying the occupationorthe environment to better support their

occupational engagement” [26]. In recent yearsoccupational therapy added concepts such asoccupational justice [27-29], ecologicalsustainability of occupations [30], occupationalsatisfaction [31,32], occupational enablement [33]and other areas [34] to its focus. According toYerxa,oneofthefoundersofthefieldoccupationalscience in the 1990’s, occupational science is anemergingbasicsciencewhichsupportsthepracticeof occupational therapy [35].Occupational scienceisseentoassistindevelopingtheunderstandingofthe occupational nature of humans [36,37] as amethodofachievingsocialjusticeandsocialreform[38] and it engages with many occupationalconcepts(Table3in[39]).1.2. Occupational Therapy, Occupational Science and Innovation Thefieldsofoccupationaltherapyandoccupationalscience both have narratives around innovation.Forexample,innovationislistedasonevalueoftheCanadian Association of Occupational Therapists[40]. The Canadian Association of OccupationalTherapists has an award for innovative practicewhich is given for “exceptional leadership andinnovation in the application of evidence-basedprinciples of occupational therapy to clinicalpractice” which includes “client service, consumeradvocacy, policy development, communitydevelopment,educationand/orfieldwork”[41].Onthe webpage of the Canadian Association ofOccupational Therapists it is stated that the“nominees shall have had a positive impact onclients, thecommunityand/ortheadvancementofoccupational therapy clinical practice” [41].Occupational scientists are seen to “studyways ofmeasuring participation, develop new andinnovative methods of intervention to helpindividuals engage in activities, and examine theimpact of participation on an individual’s healthandwell-being”[42].1.3. Code of Ethics and Occupational Therapy Organizations Codes of ethics are documents that are developedto give guidance to organizations and groupsworkingunder them.TheCanadianFrameworkforEthical Occupational Therapy Practice addressestheethicsprinciplesofautonomy,beneficence,non-maleficence, and justice [43]. Ethics is used as anumbrellaterm,combiningelementsof identityandknowledge, as an everyday way of behaving andwhat each person values and considers important[43]. The framework primarily discusses theprofessionalethicalconductsthatareimportantforoccupational therapists to follow in a way that is


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“technically proficient and honors the stories andlived experience of both the therapist and theclient”[43].

Occupational therapists are furthermoreexpected to be courageous, competent, mindful,respectful, sensitive, and reflective when they areworkingwithclients,asoccupationaltherapistsareaccountabletothosetheyserveandtosociety[43].According to theWorldFederationofOccupationalTherapy Code of Ethics, occupational therapistsmust maintain many personal attributes such asintegrity, reliability, openmindedness, and loyalty[44] . Occupational therapists must respect theirclients and their unique situation as well as notdiscriminate against their clients and keep theclient information confidential [44]. Occupationaltherapists must be able to collaborate with otheroccupationaltherapistsaswellasotherprofessions[44]. A combination of knowledge, skills andevidence must be acquired by the occupationaltherapist to help their clients in the best way aswell as to improve their professional field [44]. Italsostatesthattheoccupationaltherapyfieldhastobe promoted to the public, other professionalorganizationsandgovernmentbodies inanethicalway[44].1.4 Ethics and Innovation Therearemanydiscoursesaround innovationandethics for example medical technology [45],inclusive innovation [46], critical social innovation[47], tripartite innovation for global health [48],sticky ethics and corporate responsibility [49],ethical considerations in the innovation business[50], thepolitics of bloodethics [51], the ethics ofclinical innovation in psychopharmacology [52],legal ethics and technological innovation [53],ethical technology management and innovation[54],and theethicsof innovation [55].93%of thearticles in the Journal of Responsible Innovationmention words starting with ethic [56]. Empiricalethics and responsible innovation are linked [57]and ethics education is seen as useful forresponsibleinnovation[58].

Giventhatethicalreasoningisseenasessentialfor guiding scientific, technological and innovationdevelopments, given Sherwin’s concern thatethicists“lacktheappropriate intellectualtools forpromoting deepmoral change in our society” ([1]quotedin[2])andthatmembersof thepublicsuchasparentsofchildrenwithdisabilitiesdonotperseuse ethical theories and ethical reasoning tohighlight their problems [3] and given thatoccupational therapy andoccupational science seeinnovationas important for their respective fields,thepurpose of this studywas to investigatedhowthefieldsofoccupationaltherapyandoccupational

science engagewith ethicswithin their innovationcovering academic literature and whetheroccupational therapy and occupational sciencewere mentioned in academic journals thatcontainedwordsstartingwith“ethic”inthetitle.2. Data Source and Sampling We employed three approaches accessing threetypes of sources to generate descriptivequantitative and qualitative data answering thequestionsthestudyposed.

Approach 1: We accessed five occupationaltherapy journals of different backgrounds(American Journal of Occupational Therapy, BritishJournal of Occupational Therapy, Canadian Journalof Occupational Therapy, Scandinavian Journal ofOccupational Therapy, and Hong-Kong Journal ofOccupational Therapy) and the Journal ofOccupationalScience.

Wesearchedthewebsitesearchenginesofthefive occupational therapy journals and theoccupational science journal for the term“innovation” in the abstracts of articles onMay 5,2015. We identified n=121 articles from theAmerican Journal of Occupational Therapy, n=129articles from the British Journal of OccupationalTherapy, n=142 from the Canadian Journal ofOccupationalTherapy, n=19 from theScandinavianJournal of Occupational Therapy and n=6 articlesfrom the Hong-Kong Journal of OccupationalTherapy and n=41 articles from the Journal ofOccupational Science. The articles weredownloadedasPDFanduploadedintoAtlas-Ti.7,aqualitative analysis software, for descriptivequantitativeandqualitativecontentanalysis.

Approach 2: We accessed three academicdatabases (EBSCO All - an umbrella database thatconsists of over 70 other databases includingMedline; Scopus andWeb of Science) that containjournals that cover a wide range of topics. Thesedatabases include many journals that haveoccupationaltherapyinthetitleofthejournalsuchas:Britishjournalofoccupationaltherapy;Americanjournal of occupational therapy; Australianoccupational therapy journal; Physical &occupational therapy in pediatrics; Occupationaltherapy in health care; Physical & occupationaltherapy in geriatrics; Canadian journal ofoccupational therapy; Scandinavian journal ofoccupational therapy; Occupational therapy inmental health; Indian journal of physiotherapy &occupational therapy; Occupational therapyinternational; Indian journal of occupationaltherapy; Mental health occupational therapy;Occupational therapy journal of research; South


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African journal of occupational therapy; NewZealand journal of occupational therapy; Journal ofoccupational therapy, schools & early intervention;Hong Kong journal of occupational therapy; IrishjournalofoccupationaltherapyandPhysiotherapy&occupationaltherapyjournal.

We searched (May 19, 2015) the threeacademic databases for the terms “occupationaltherapy” and “innovation” in the abstract (EBSCOALL), abstract, title, keyword (Scopus), Web ofScience (topic: meaning Title, Abstract, AuthorKeyword and Keywords Plus®) limiting thesearches to articles, editorialmaterial, review andproceedingpapers(WebofScience);review,article,conference paper, editorial (Scopus) and scholarlypeer reviewed journals (EBSCO ALL). Of thepositive hits n=108 were duplicates from thesearchconductedinApproach1anddiscarded.Then=71newarticles foundweredownloadedasPDFuploaded into Atlas-Ti a qualitative analysissoftware for descriptive quantitative andqualitativecontentanalysis.

Approach 3:Wesearched for thepresenceof theterms “occupational science” and “occupationaltherapy” in the abstract of articles from journalswithwords startingwith “ethic” in the title of thejournal that are listed in EBSCO All and Scopus(March3,2016).WedidnotuseWebofScienceasitdoes not generate a hit count for all publicationswithwordsstartingwith“ethic”inthejournaltitle.3. Data Analysis To obtain descriptive quantitative data weemployedthreeapproaches.

Approach 1: We searched all the downloadedarticles obtained as described under section 2.1.Approaches 1 and 2 for terms and phrasecontaining words starting with “ethic” and usingtheadvancedsearchfeatureofthesoftwareAdobeAcrobatXProtorecordthenumbersofhowoftenagiventermorphraselinkedtoethicswaspresentinagivenarticleandinhowmanyarticles(Table1).

Approach 2: We searched all the downloadedarticles obtained as described under sectionapproach 1 and 2 for containing words startingwith “ethic”, the following n=14 ethics terms:“value”, “philosoph*”, “justice”, “moral*”,“autonomy”, “bioethics”, “dignity”, “care ethics”,“virtue ethics”, “feminist ethics”, “human ethics”,“public health ethics”, “beneficence”, “maleficence”and n=19 ethical theories: “Kant”, “Socialist”,“Egalitarian”, “Moral Relativism”, “IndividualRelativism”, “Cultural Relativism”, “PsychologicalHedonism”, “PsychologicalAltruism”, “FemaleCareBased Ethics”, “Virtue Theories”, “Samuel

Pufendorf”, “Rights Theory”, “WD Ross”,“Consequentialism”, “Deontology”, “Utilitarianism”,“Preference Utilitarianism”, “Libertarian” and“Feminist Approach”. The 34 terms were takenfrom Beauchamp and Childress’ 1979 paper“Principle of Biomedical Ethics” [59] as well asencyclopediaorwebsources[60-63].

Weusedagain theadvancedsearch featureofthe software Adobe Acrobat X Pro to record thenumbers of how often a given term or phraselinkedtoethicswaspresentinagivenarticleandinhow many articles (Table 2). We also used theadvanced search feature of the software AdobeAcrobatXProtorecordhowoftenatermlinkedtoethics was present in an article within 20 wordsfromawordstartingwith“inno”(Table2).

Approach 3: We recorded how often the terms“occupational science” and “occupational therapy”were present in the abstract of articles fromjournalswithawordthatstartswith“ethic” inthetitleof the journal thatare listed inEBSCOAll andScopus(March3,2016)(section3.1.3.).Thedescriptivequantitativedatageneratedby thethree approaches was generated by both authorsandnodiscrepancywasevidentincountsobtainedbythetwoauthors.

To obtain qualitative data the downloadedarticles were auto-coded for words starting with“inno”whichgeneratedn=1075hitsandforwordsstartingwith “ethic”whichgeneratedn=1442hits.A co-occurrence code was then generated thatindicated the co-occurrence of the two wordswithin20words(n=21quotes).Athematicanalysiswasperformedontheco-occurrence(n=21quotes)and the n=1442 ethics-related quotes. Bothresearchers performed the analysis and resultswere compared between the researchers. Nodisputeoccurredpartlyduetothefewarticlesthatlinkedcontenttoethicsandrelatedterms.4. Limitations Only documents that were in English wereconsidered. Wedidnot cover all theoccupationaltherapy journals in existence and all academicdatabases that might have articles that coveroccupational therapy and occupational science. Assuch our conclusions are linked to the sourcescoveredandcannotbegeneralized.5. Results Inafirststepwegenerateddescriptivequantitativedata on which phrases were linked to wordsstarting with “ethic” (Table 1), which of the n=34ethics terms mentioned in the section 2.1 werepresentinthesourcescovered(Table2)andhow

Table1.Thehitcountandthearticlecountforeachethicsdiscourseterm,orderedby“NumberofArticlesinOTJournals”(Secondcolumn)

Phraselinkedtowordsstartingwithethic

OTJournalsHitCounts

OTJournalsNumberofArticles(n=417)

OSJournal

HitCounts

OSJournalNumberofArticles(n=41)

DatabaseJournalHitCounts(excludingOTjournalsalreadycovered)

DatabaseJournalNumberofArticles

(n=71)(excludingOT

journalsalreadycovered)

Ethic* 1442 160 56 16 45 23Ethicsapproval 530 70 1 1 6 6Researchethics 212 53 2 2 1 1Ethicscommittee 225 46 0 0 4 3Codeofethics 98 32 0 0 3 2Ethicalconsideration 34 18 0 0 1 1Ethicsboard 16 15 3 3 0 0Ethically 25 13 3 2 1 1Ethicaldilemma 14 12 0 0 0 0Workethic 11 8 13 2 0 0Ethicalimplications 13 8 0 0 0 0Ethicsreview 11 7 0 0 1 1Ethicalprinciples 8 7 0 0 0 0Ethicalobligation 7 7 0 0 0 0Ethicalguideline 8 7 0 0 0 0Ethicspermission 6 6 0 0 0 0Ethicalconcern 5 5 0 0 0 0Ethicaldecisions 6 5 0 0 0 0Ethicalreasoning 9 4 0 0 0 0Professionalethics 3 3 0 0 0 0Ethicalstandard 5 3 1 1 1 1Ethicalpractitioner 2 2 0 0 0 0Ethicalconduct 2 2 0 0 0 0Ethicalquestion 1 1 0 0 0 0Ethicalbelief 1 1 0 0 0 0Ethicaluse 1 1 0 0 0 0Ethicalconstraints 0 0 1 1 0 0ProtestantEthics 0 0 2 2 0 0Interactiveethics 0 0 3 1 0 0AfricanEthics 0 0 3 1 0 0often occupational therapy and occupationalscienceshowupinethicsjournals.Quantitative Data: Table 1 shows how the termethicswasusedinthen=417occupationaltherapyand n=41 OS articles. Words and phrasescontaining words starting with “ethic” werementionedn=1442 in n=160 occupational therapyarticles and n=56 in n=16 OS articles. “Ethicalapproval” had the highest counts with n=530 inn=70occupationaltherapyarticles.

Table 2 shows with the hit count and thearticle count for eachof then=34ethicsdiscourseterms. It demonstrated thatmany ethical theorieswere not employed in the literature investigated,and also that key bioethics principles such asbeneficenceandmaleficencewerenotemployed.

Mentioning of Occupational Therapy andOccupational Science in Ethics Journals: Of the45,588 articles found in the databases that havewords startingwith “ethic” in the title of journals,n=5articlesmentionedoccupationaltherapyinthe

abstract. Not one article mentioned occupationalscienceintheabstract.

Qualitative Analysis: Most of the quotationsgenerated for the articles uploaded into Atlas Ti7contained content that did not engage in ameaningful or conceptual way if at all with then=34 ethics-related terms in question. As suchweonly recap here our findings for the quotesgenerated with words and phrases containingwords starting with “ethic”. First, we will discusstheonesnotlinkedtoinnovationwithina20-worddistance, and then we will discuss the quotationsthatco-occurredwith“inno*”.

Ethic* and Occupational Therapy: Althoughn=1442 quotations were generated for wordsstartingwithethicmostof thequotationsreflectabureaucraticuseofwordscontainingethic,suchasethics approval or using a term without givingcontent. Only seven articles were found to havesomecontent.

Table2.Thehitcountandthearticlecountforeachofthen=34ethicsdiscourseterms

Term OTjournalsHitCounts

OTjournalsNumberofArticles(n=417)

Numberofhits/articleswithtermsinproximity(20words)ofterminnovationinthedatabaseOTarticles

OSHitCounts

OSjournalNumberofArticles(n=41)

Numberofhits/articlewithtermsinproximity(20words)ofterminnovationintheOSjournal

DatabaseHit

Counts(n=71)

DatabaseOTNumberofArticles(n=71)

Numberofhits/articlewithtermsinproximity(20words)ofterminnovationinthedatabaseOTarticles

EthicsConceptethic* 1442 160 21/8 56 16 0 45 23 0Value 1978 269 78/21 254 33 5/2none

linkingvaluewithinnovation

495 61 0

Philoso* 721

146

2/1

105 22 2/1(notlinkingphilosotoinnovation

236 35 0

Harm 216 92 0 40 15 0 110 29 0Autonomy 185 76 13/6 8 4 0 26 11 1Justice 177 58 2/1 64 14 0 74 18 0moral* 151 61 4/2 35 17 0 67 22 0Dignity 49 22 0 4 3 0 4 4 0Beneficence 0 0 0 0 0 0 0 0 0Maleficence 0 0 0 0 0 0 0 0 0careethics 2 2 0 0 0 0 0 0 0virtueethics 0 0 0 0 0 0 0 0 0feministethics 0 0 0 0 0 0 0 0 0publichealthethics 0 0 0 0 0 0 0 0 0

bioethics 21 3 0 0 0 0 0 0 0EthicalTheories

Egalitarian 7 6 0 3 2 0 0 0 0

Socialist 0 0 0 0 0 0 4 3 0Hedonism 1 1 0 0 0 0 0 0 0Libertarian 1 1 0 0 0 0 0 0 0FeministApproach

1 1 0 0 0 0 0 0 0

MoralRelativism 0 0 0 0 0 0 0 0 0IndividualRelativism

0 0 0 0 0 0 0 0 0

CulturalRelativism

1 1 0 1 1 0 4 4 0

PsychologicalHedonism

0 0 0 0 0 0 0 0 0

PsychologicalAltruism

0 0 0 0 0 0 0 0 0

FemaleCareBasedEthics

0 0 0 0 0 0 0 0 0

VirtueTheory 0 0 0 0 0 0 0 0 0SamuelPufendorf 0 0 0 0 0 0 0 0 0RightsTheory 0 0 0 0 0 0 0 0 0WDRoss 0 0 0 0 0 0 0 0 0Consequentialism 0 0 0 0 0 0 0 0 0Deontology 0 0 0 0 0 0 0 0 0Utilitarianism 0 0 0 0 0 0 0 0 0PreferenceUtilitarianism

0 0 0 0 0 0 0 0 0


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Abernethy, inher2010 articleTheassessmentand treatment of sensory defensiveness in adultmentalhealth:a literaturereview,stated that noneof the articles in her literature review coveredethicalimplications[64].Twoarticlesengagedwiththephrase“ethicalreasoning”.Onelinkedissuesofsustainability with occupational therapyphilosophy and discusses how employing asustainability lenswithprofessional reasoning canhelppractitionersintegratesustainabilityintotheirpractice [65]. The authors stated: “In addition toaddressingissuesrelatedtoindividualclientcareinour day-to-day practice, occupational therapypractitioners should also consider ethicaldimensions of the issues by utilizing thesustainabilitylensdiscussedinthispaper.Thislensencourages practitioners to focus on theconsequences of our actions and consider ourduties, responsibilities, and the morally correctactiontobetaken,which isanextensionofethicalreasoning”[65].

WendyWood’s article covered the process ofcurriculum redesign of an occupational therapyMaster’s degree in which Wood engages with theterm “ethical reasoning”. Wood states “Ethicalreasoningisdefinedinthecurriculumasprocessesofenactingthehigheststandardsofethicalconductand of generating solutions to problems on thebasisof a systematic studyofmorality.Thearticleexamined current threats to the field “in light ofpast compromises that weakened occupationaltherapy’ssociopoliticalpositionanddiminisheditspower to meet the occupational needs of peopleandsociety”[66].

Taff et al assessed “how contemporarychallengesandaneedforethicalidentityrequireaphilosophical shift”[67] and their article has asection called “Occupational Rights and HumanDignity: Defining Ethics and Accountability” [67].Thephrase“ethicalconsiderations”wasmentionedin n=25 articles. However, the phrase was mostlylinked to ethics approval. Again, Taff et al providesome content: “There is some debate in recentyears about the core values as well as the ethicalconsiderations in the definition and practice ofoccupationaltherapy”[67].Ethicaldilemmaswerebrought to light in one paper where they are“related to an inability to offer new technology toall clientsdue to fundingshort falls” [68]wherebythe lack of access was seen as being able to beaddressedandresolvedthroughpublicopinionandclientexperience[68].

Vincent reported on a survey saying thatpeoplesayethicsisimportant[69].However,itwasnotexplainedwhatismeantwithethics.Althoughthe term “ethical implication” was mentioned inn=8 articles in only one case was it not linked to

ethics approval. Castro et al. stated “As culture isdifficult to define, and has political and ethicalimplications, an investigation into its usage iswarranted” [70]and flagged thepossibility that “alackof critical insight intoprofessional knowledgeincreases the risk that occupational therapy willremainsatisfiedwiththecurrentunderstandingofculture, based on the dominant knowledge. Thedisciplinecouldfailtoaddressthepolitical,ethical,and theoretical issues required to reach thetargeteddiversityinitspractice”[70].

Taff et. al in their article The Accountability–Well-Being–Ethics framework: A new philosophicalfoundation for occupational therapy, engage withRortyian thoughts and they have “particularrelevanceinoccupationaltherapy,wherethefocuson possibilities and local meanings resonatesheavily with people’s lived experience. Hiscontextualism differs from most philosophicalperspectivesbecauseitisnotconcernedwithgreattruths. Instead, it is a ‘‘lowercase’’ philosophy thatponders the joys, dilemmas, and improvement ofdaily life. The discoveries of science are crucial tosupport the continued growth of professionalknowledge. No less important, though, is thephilosophicalviewofthepersonasanactiveagentinachievingagoodlife,anditisequallycriticalthatthis facet of occupational therapy be sustained tofacilitate both local and global influence. Theperson-centredphilosophymustbenourished,anditisherewhereRortyplaysakeyrole.Rortybringsphilosophy out of the realm of scientists andacademics and presents it as a tool for solvingproblems and achieving equity in everydayexperience. This ‘‘lower-case’’ philosophy requirescollaboration, promotes capabilities, and isavailabletoeveryone.Assuch,itisavaluableallytooccupational therapyas theprofessionseekswaysto address the new challenges of changing healthcare policies, globalization, and sociopolitical andclimate-driven determinants of health. TheRortyian concepts of hope, solidarity, andcontingency provide new and needed conceptsupon which occupational performance,participation, and well-being can be addressed aswemovethroughthe21stcentury”[67].

Ethic*andOccupational Science:Wordsstartingwith ethic were mentioned in n=16 articles n=56times with n=6 articles having some content. Onearticle stated that occupational science needs toengagewithethicalconsiderationsinorderforittobeasociallyresponsible[71].

According to Rudman, it is important toconsider “how occupational science is ethically,morally and politically responsible for theknowledge it generates” which “challenges


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occupational scientists to redefine the boundariesbetween ‘professional’ (sometimes framed asapplied) and ‘scientific’ (sometimes framed asbasic) knowledge and practices” [72] and the“broader dialogue addressing the types ofknowledge production falling within the domainandpracticesofoccupationalscienceisessentialtooptimize relevance and ethical and socialresponsibility”[72].Willis linkProtestantethics tosocialhistoryofdeadlines[73].

Halahan states “competence can be regardedasaprocess*notmerelyasanoutcome*andusedtoenrich practices by opening the arena of humanaction to its ethical, or value-laden, nature.Participants in occupation become agents of safe,effective, lifegiving, meaningful pursuits, not meretechniciansofaction,becausecompetenceconsistsasmuch in people’s ability to articulate why theyactthewaytheydoasitdoesintheircapacitytoactin the first place” [74]. In an article by ElelwaniRamugondo, an ethics idea governing humanengagement called Ubuntu, an interactive ethicsalsocalledAfricanethics, isdiscussedasit ismoreof a community based ethics rather than justconcerning the individual [75]. In this article theUbuntu “raises consciousness around theresponsibilityofbothindividualsandcommunitiesto allow meaningful existence for all” [75]. Thisform of ethics governing is concerned with howeachindividualimpactsotherindividuals[75].

Dickie et al make a case for “TransactionaloccupationalsciencebasedonDeweyandhisallies”whichtheyassertis“asolidfoundationonwhichtoplace the concept of occupation” as it “provides aphilosophical basis for the importance ofoccupationineverydaylifeandbecauseit“enablesoccupationtobedirectlyrelatedtoawiderrangeofexperience and inquiry, from ethics to culturalanalysis to political issues such as occupationaljustice”[76].

Ethic* and Innov*: N=21 quotations in n=8occupational therapy articles were generated forthe presence of “inno*” and “ethic*” within 20words. All but two articles used the term “ethicsapproval” and did not use ethics in relation toinnovation.Noarticlewasobtainedfor“inno*”and“ethic*” within 20 words distance in theoccupationalsciencearticles.

As to the two occupational therapy articlesmentioning “ethic*” and “inno*” within 20 wordsdistance; Hoffmann in a 1979 article ContinuingEducation: An Answer to Professional Obsolescencerecognized “that new innovations have alsofostered a host of problems” [77], stating furtherthat“Organtransplants,forexample,haveopenedaPandora's Box in terms of ethical questions. The

debate of prolonging life by mechanical meanswhen there is virtually no hope for recovery, hasfosteredamajordebateof theright todie issue.AgoodexampleofthissituationistheKarenQuinlancase in New Jersey. Another example is biologicalresearch on recombinant DNA. It is now possiblefor scientists to combine genetic material fromdifferentmolecules and generatebiologicalmatterin the laboratory that are not found in nature.Another example is the recent debate concerningtesttubefertilization”[77].However,Hoffmandoesnot explicitly statewhat the ethical issues are andhe does not employ ethical reasoning to discusssomeofthespecificinnovationshighlighted.

AnitaAtwal’spaperstatedthat“Thechallengefor action researchers is to act ethically. Wheninstigating change in the health service,investigators must let professionals drive changeinnovationseven though the investigatormay findhimself or herself challenging assumptions. Actionresearchers have to ensure that the quality, valueand honesty of their inquiries are not jeopardisedbyunrecognisedbiasandinfluence”[78].6. Discussion Based on the articles investigated, our findingssuggest that the occupational science andoccupational therapy academic literature aroundinnovation did not engage with ethics in asubstantial matter such as employing ethicaltheories or ethics principles. Further, we foundlittleengagementwithoccupationaltherapyandnoengagement with occupational science in ethicsjournalssearched.Wepositthatthisisproblematicgiven that occupational therapy and occupationalscience is seen to be in constant need to innovate[40-42] and given that science and technologyproducts are an area of interest to occupationaltherapyandoccupationalscience[79-86],productsthat constantly are influencedbyadvancements inscience and technology. Furthermore, advances inscienceand technologyare seenas innovativeandthey influence innovation discourses includingsocialinnovation.AsJarvisstates:“AsstatedinourCodeofEthics,itisourobligationtokeepuptodatewithchangesinourfield”[87].Thisquoteistryingto show the connection that ethics has withinnovationintheoccupationaltherapyfield[87].

Itisalsoaproblemfromtheperspectiveoftheethics field. Ethicists want to influence social andpoliticalchange;butsomeseeproblemswithdoingso. Sherwin recently stated: “We lack theappropriate intellectual tools for promoting deepmoral change in our society. To find ways ofaddressing these difficult questions, we need tolearnabouttheleversofsocialandpoliticalchange.


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We probably need also to develop skills incommunicating effectively with the public and toengage in some version of political lobbying. Inother words, we must develop new types ofunderstanding and new ways of practice” ([1]quotedin[2]).Ourfindingsprovideevidencefortheproblem Sherwin outlines. Ethical theories, one ofthemain tools used in academic ethics discoursestojustifycertainreasoningandconclusionsarenottaken up by the occupational therapy andoccupationalscienceacademicliterature.Givenourfindings, it is reasonable to assume thatoccupational therapists do not employ ethicaltheoriesintheirreasoning.

Sherwinasksforthere-orientationoftheoretictools used in bioethics to guide the field in a newdirection [1]. She asks for adopting an ethics ofresponsibility;explorationoftheresponsibilitiesofvarious kinds of actors and relationships amongthemandtheexpansionofthetypesofparticipantsengaged in bioethics ([1] quoted in [2]).We positthatoccupationaltherapyandoccupationalsciencebasedontheirfocusonoccupationdealwithmanyissues that raise ‘ethical issues’. As such we positthat the active and knowledgeable involvement ofoccupational therapy scholars, students,practitionersandoccupationalsciencescholarsandstudentsisfittingSherwin’sdemand.Thisinclusionhowever demands that occupational therapyscholars, students and practitioners andoccupationalsciencescholarsandstudentsemployethicaltheoriesandethicalreasoningbeyondwhatwe foundwhichwepositmeans thata curriculumchange is needed that trains occupational therapyand occupational science students how to useethicaltheoriesandethicalreasoning.Indeedgivencertain emerging science, technology andinnovation development such as using robots foremployment [88] it seems fruitful to develop acommunity of practice around an “ethics ofoccupation”aphrasewhichso faronlyhas41hitsinGooglescholarwherebythe focus isnoton jobsand being busy but occupation of ones space byothers.

To develop an ethics of occupation as in job,work, and being busy fits with the goal ofoccupational therapy and occupational science. Italsoisanpressingissue,givenanticipatedtrendsinrobotics [88], 3D printing [89-91] and molecularmanufacturing(StarTrekfoodreplicator)aprocesswhereamachinebuildsupproductsatombyatom[92] and areas such as the body enhancements ofhumans which will impact ability expectations ofhumans linked to occupation and with that theeducationofhumans[93].

7. Conclusion Ethics is discussed in relation to innovation forsome time. Innovation plays an important role inoccupational therapy and innovation science.However, the occupational therapy andoccupational science literature around innovationdid not engagewith ethics in a substantialmattersuchasemployingethicaltheories,ethicsprinciplesand ethical reasoning. More concrete engagementwith ethics is needed in occupational science andoccupational therapy in order to clarify what isdeemedethicalandwhatethicalissuesmightarisein termsof innovation in theoccupational therapyfield. References 1. Sherwin, S. Looking backwards, looking forward:Hopesfor bioethic's next twenty five years. Bioethics2011,25,75-82.

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Call for Papers: The Eleventh Kumamoto University International Bioethics Roundtable: Philosophy and practice of bioethics across and between cultures,

18-19 November 2017, Kumamoto University, Japan; Contact: Kimiko Tashima, Email: [email protected]

On Being the Hippocratic Doctor: Views of House officers in a Nigerian Teaching Hospital -OnochieOkoyeDepartmentofOphthalmology,CollegeofMedicine,UniversityofNigeria,PMB01129,Enugu,NigeriaEmail:onochie.okoye@unn.edu.ng-FerdinandMaduka-OkaforDepartmentofophthalmology,CollegeofMedicine,UniversityofNigeria-AnthoniaUdeajaDepartmentofophthalmology,AnambraStateUniversityTeachingHospital,Awka,AnambraState,Nigeria-AbaliIChukuFederalMedicalCenter,Umuahia,Nigeria Abstract Medicalstudents inmanycountriestakeamedicaloathongraduationfrommedicalschool.Giventhatthereislittleornoformalmedicalethicseducationin many Nigerian medical schools, the currentrelevance of swearing to these medical oaths isbeing questioned. This study determined mainlythe views of pre-registration house officers(PRHOs)ontherelevanceoftheHippocratic-basedmedical oaths and some selected issues related tothe ideals espoused therein. Using self-administered questionnaires, a cross-sectionalsurveyofPRHOswas conducted in2013as apre-orientation workshop activity in Nigeria.Respondents were simply required to indicate ifthey agreed/disagreed with 29 perceptionstatements related to the medical oaths and theirideals. Simple descriptive analysiswas done usingthe Statistical Package for Social Sciences version19.Thesample included63malesand41 females,whohadallsworntothePhysician’sOathattheir9respective medical schools. Though only tworespondents (1.9%)were confident about recitingthe Physician’s oath/any medical oath frommemory or recalling all the specific detailscontainedinit,themajorityofthemagreedwithallthe traditional ideals espoused in theHippocratic-basedoaths,includingtheprohibitionsonabortion,euthanasia/physician-assisted suicide and sexualmisconduct. Contemporary issues like doctors’strikeactions, jobsecurity/self-preservationissuesand demand for payment of hospital fees beforeservice were shown to be contentious issues forwhich there was no explicit guidance from themedical oaths. For these oaths to gain greaterrelevance and priority among these doctors, theyshouldberecitedwithin thecontextofareformed


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Lack of ethical reasoning in the innovation narrative of … · 2017-09-30 · innovation narrative...

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