An Analysis of AOTA's Advisory Opinion on Social Justice
Sep 15, 2013
In 2010 the AOTA Ethics Commission rewrote the organization’s code of ethics to include a new and controversial ethical requirement, social justice. In that same year, the Ethics Commission published what is commonly known as the “Advisory Opinion on Social Justice,” although its official title is “Social Justice and Meeting the Needs of Clients” (found here: http://www.aota.org/Practitioners/Ethics/Advisory/Social-Justice.aspx).
An “advisory opinion” is a document issued by an organization to explain one of the organization’s rules. An advisory opinion offers guidance on the application of a rule. It made sense for the Ethics Commission to issue an advisory opinion on social justice so that practitioners could learn how to apply the new ethical requirement to concrete situations. (Note: the AOTA Code of Ethics and Ethics Standards will occasionally be referred to below as the Code of Ethics or simply the Code).
One of the major events to ensue with the enactment of the new Code of Ethics was that three AOTA members, Kathy Grace, Claudette Reid and Dr. DiZazzo-Miller, filed a motion to remove the social justice requirement. As part of their motion, Grace et al. wrote that the social justice requirement “is politically charged.” And therefore, the social justice requirement brought “politics into a code of ethics, offend[ing] those [with] differing views and facilitate[ing] division” (see Grace et al.’s “Supporting Document”). In other words, Grace et al. were trying to keep the integrity of the Code of Ethics, which promotes the values of inclusion and diversity. The politically divisive social justice requirement robs the Code of Ethics of integrity precisely on the issue of inclusion regarding those with diverse political and philosophical perspectives.
As part of their argument, Grace et al. not only criticized the text of the Code of Ethics, but the advisory opinion on social justice as well. They reviewed the advisory opinion to see if its contents could justify the social justice requirement. They concluded, however, that “AOTA’s Advisory Opinion on Social Justice does not articulate nor validate the inclusion of the concept of social justice . . . in our Code of Ethics [because all of the] scenarios in this document are resolved using other principles” (see motion by Grace et. al). The references to “scenarios in this document” refers to the situations created for the advisory opinion which were to serve as teaching tools on how to use the Code of Ethics to resolve ethical problems. What Grace et al. discovered was that the advisory opinion on social justice offered nothing to justify the social justice requirement in the Code of Ethics because all the situations discussed were easily addressed with the other parts of the Code of Ethics.
Grace et al. did not provide a detailed analysis of the advisory opinion to substantiate their position. That is the purpose of this article.
Before examining the advisory opinion, the reader should be introduced to the structure of the 2010 AOTA Code of Ethics. At its core are seven principles that are numbered 1-7. The social justice requirement is formally known as “Principle 4.” In addition to a title and subtitle, each principle is divided into two main parts. The first part explains the principle. The second part contains subsections listed in alphabetical order. These subsections are generally meant to be the practical application of the principle. (Principle 4 has seven subsections and they are titled A-G. See 2010 Code of Ethics here: http://www.aota.org/Consumers/Ethics/39880.aspx). The seven principles of the Code of Ethics are:
3. Autonomy and Confidentiality
4. Social Justice
5. Procedural Justice
Two curious facts will jump out at anyone who reads the advisory opinion on social justice: one is how often principles other than social justice are referenced in the document; the second is the paucity of references to Principle 4 itself.
The following are all the in-text references to the various principles in the Code and their subsections, in the order they appear:
The list above is meant to serve as a skeleton with all the muscle and skin and removed. It is meant to give the reader an outline of the principles discussed in the advisory opinion. The list shows that there were 12 references to the principles and some of their subsections. Only 3 of these references, that is 25% of them, are to Principle 4, Social Justice. That already is a problem. If you are introducing a new and controversial requirement into the Code of Ethics and your references to it in the advisory opinion constitute only 25% of the total references, something is wrong.
But even this 25% is exaggerated. There are two reasons for concluding the 25% number is exaggerated. For one, Subsection E of Principle 4 is mentioned twice. And second, Subsection E is not new to AOTA’s Code of Ethics. It was actually transferred from the 2005 Code of Ethics where it was listed as Subsection C from the Principle of Beneficence. At this point it is necessary to give the content of this Subsection.
First, the reader is asked to look to the language of Principle 4, Social Justice Subsection E of the 2010 Code of Ethics. It states that therapists are required to:
“Make efforts to advocate for recipients of occupational therapy services to obtain needed services through available means.”
Next is the language from the 2005 Code of Ethics, under Principle 1, Beneficence. Subsection C. It requires therapists to:
“Make every effort to advocate for recipients to obtain needed services through available means.”
As can be readily seen, the language from the Principle of Beneficence Subsection C in the 2005 Code of Ethics was merely transferred to the Principle of Social Justice Subsection E in the 2010 Code of Ethics. Keep in mind that the purpose of this article is to see if the advisory opinion on social justice justifies a new and highly controversial requirement. But what has just been demonstrated is that two of the references to the social justice requirement in the advisory opinion are nothing new. They are simply borrowed words from the 2005 Code of Ethics that were given a new label in the 2010 Code of Ethics.
Recall that Grace et al. said that one of the reasons the advisory opinion failed to justify the social justice requirement was that all the issues presented in the opinion were easily addressed by all the other principles in the Code. The fact that the Ethics Commission had to transfer subsections from other parts of the old Code into the principle of social justice validates this argument.
So, where at first glance it appeared that 25% of the references in the advisory opinion were to Principle 4, Social Justice, some research into the language of Principle 4 revealed that two of those references do not count, as these references are really referring to language in the old Principle 1, Beneficence from the previous Code. With these two references invalidated as “new material,” the advisory opinion is left with only one reference to Principle 4. That reference is to Subsection G. Subsection G requires therapists to consider working for free for some patients. That is all the new material provided by the Ethics Commission in the advisory opinion: consider working for free.
Such advice can hardly justify the inclusion of an incredibly divisive and controversial requirement in the Code of Ethics. And even here, there is nothing really new in the advice to consider working for free. This is because the Principle of Beneficence in the 2010 Code of Ethics already explains Beneficence as “kindness,” “charity,” and “helping others.” Since charity is about donating one’s time or money, Subsection G from Principle 4 is conceptually redundant.
This means that even having one reference to Principle 4 actually drops down to no references, as the idea contained in Subsection G of Principle 4 is already found in Principle 1.
The only logical conclusion one can draw from an analysis of the advisory opinion on social justice is that it fails to justify the social justice requirement. Grace et al. were right: the scenarios addressed in the advisory opinion are easily resolved by using all the other parts of the Code of Ethics.