Ethical tensions in occupational therapy practice: Conflicts and competing allegiances

BACKGROUND.: Ethical tensions inevitably arise in practice in light of diverse agendas embedded in practice contexts. Such tensions can contribute to moral distress and lead to professional burnout and attrition. Despite potentially serious implications, little work has been done to examine how various allegiances in occupational therapy practice can set up ethical tensions. PURPOSE.: In this article, we present findings of an exploratory study examining conflicting allegiances in occupational therapy. METHOD.: Using collective case study methodology, we examined ethical tensions reported by seven occupational therapists practicing in different settings in Southwestern Ontario. FINDINGS.: Ethical tensions were seen to arise in ways that highlighted competing allegiances to participants' own values, clients, others in the context, colleagues, employers, and regulatory colleges. IMPLICATIONS.: The findings open a discussion informing how practice settings can better facilitate practice directed at responding to client needs while also meeting the various demands imposed on occupational therapists.