The bridge from ethics to public policy: implications for occupational therapy practitioners.

109 The delivery of occupational therapy in ever changing systems has resulted in an increased focus on ethical concerns (Brown & Gabriel, 1995; Curtin, 2000; Fisher, 1997; Jacobson & Pomfret, 2000; Lohman & Brown, 1997). In recognition of ethical issues, the American Occupational Therapy Association (AOTA) has developed three documents that guide ethical practice: the Occupational Therapy Code of Ethics (American Occupational Therapy Association [AOTA], 2000), the Core Values and Attitudes of Occupational Therapy Practice (AOTA, 1993), and the Guidelines to the Occupational Therapy Code of Ethics (AOTA, 1998). When society cannot solve ethical and other societal concerns, then public policy develops and these policies reflect values considered to be important by society (Shapiro, 1999). Therefore, understanding ethical principles and ethical reasoning applies not only to clinical practice but also to larger health care and disability issues addressed by public policies. In this paper the authors propose that therapy practitioners consider the Occupational Therapy Code of Ethics (AOTA, 2000) in a broad manner by applying the document to health care and disability public policies. Application of this document involves critical analysis of policy issues enabling therapists to come to their own positions. Therapists do not necessarily need to support the AOTA position about a particular policy, or any another suggested position. However, they do need to apply clinical reasoning to arrive at a position that they can defend ethically. The Individuals With Disabilities Education Act (IDEA) (1997) (Pub. L. 105-117) will be used as an exemplar for this discussion. In the first section of the paper, we present a brief history of the IDEA as a foundation for further discussion. Understanding the history of a public policy helps to develop a broader perspective about the issues influencing legislation. In the second section we discuss how the Occupational Therapy Code of Ethics (AOTA, 2000) can be applied to understand and critically analyze ethical issues with the IDEA or with any public policy. The last section includes a list of reflective questions to help therapy practitioners critically analyze the ethical issues of public policy.