Topic 5.3 Ethical Decision-Making and Professional Accountability

Infection prevention and control (IPC) is not solely a technical or scientific discipline; it is also deeply rooted in ethics. Occupational Therapists (OTs) regularly encounter situations in which competing interests, values and responsibilities must be carefully balanced. Decisions intended to reduce infection risks may simultaneously restrict occupational participation, reduce autonomy, alter therapeutic relationships or affect the welfare of assistance animals. Ethical decision-making provides a structured approach to navigating these complex situations while ensuring that care remains person-centred, evidence-based and professionally accountable.

Ethical practice requires more than simply complying with legislation or organisational policies. While laws establish minimum standards of conduct, ethical decision-making requires Occupational Therapists to consider what ought to be done in a particular situation by integrating professional values, current evidence, client preferences and broader societal responsibilities. Infection prevention decisions often involve balancing the rights of individuals against the safety of others, particularly during communicable disease outbreaks or public health emergencies. Occupational Therapists must therefore exercise sound clinical judgement while recognising that there may not always be a single “correct” answer.

Professional accountability complements ethical decision-making by requiring practitioners to accept responsibility for their actions, decisions and omissions. Accountability extends to maintaining competence, recognising limitations, documenting clinical reasoning, seeking appropriate supervision and acting in the best interests of clients while protecting public safety. Through reflective practice, collaboration and ongoing professional development, Occupational Therapists demonstrate accountability to clients, employers, colleagues, regulatory bodies and the wider community.

The One Health framework further broadens ethical responsibility by recognising that infection prevention decisions may affect human health, animal welfare and environmental sustainability simultaneously. Ethical practice therefore requires Occupational Therapists to consider the broader consequences of their decisions while promoting the wellbeing of individuals, assistance animals and the communities in which they live.

This topic explores ethical principles, professional accountability, ethical decision-making frameworks and common ethical challenges encountered in infection prevention and occupational therapy practice.

Ethics in Infection Prevention

Ethics refers to the principles and values that guide decisions about what is right, fair and responsible.

Within infection prevention, ethical decision-making supports Occupational Therapists to:

• protect client safety
• respect individual rights
• minimise harm
• promote equitable access to services
• maintain public trust
• support evidence-based practice
• balance competing priorities.

Ethical reasoning becomes particularly important when infection prevention measures affect clients’ independence, participation or access to healthcare.

Core Ethical Principles

Although ethical frameworks vary, several fundamental principles underpin healthcare practice.

Beneficence

Beneficence requires practitioners to act in ways that promote the wellbeing of clients.

Examples include:

• reducing infection risks
• promoting safe participation
• providing evidence-based education
• supporting recovery
• facilitating access to healthcare.

Infection prevention measures should aim to improve health outcomes while supporting meaningful occupational participation.

Non-maleficence

Non-maleficence is the obligation to avoid causing unnecessary harm.

Occupational Therapists support this principle by:

• implementing infection prevention measures
• recognising hazards
• practising within scope
• maintaining competence
• preventing avoidable disease transmission.

However, practitioners must also consider whether infection prevention measures themselves may unintentionally cause harm through social isolation, occupational deprivation or reduced access to essential services.

Respect for Autonomy

Autonomy recognises an individual’s right to make informed decisions regarding their own healthcare.

Occupational Therapists should:

• provide accessible information
• support informed decision-making
• respect client preferences
• encourage shared decision-making
• recognise supported decision-making where appropriate.

Respecting autonomy does not mean agreeing with every decision but ensuring clients have opportunities to make informed choices whenever possible.

Justice

Justice refers to fairness, equity and the equitable distribution of healthcare resources.

Occupational Therapists should consider whether infection prevention measures:

• provide equitable access to services
• avoid discrimination
• support inclusion
• minimise barriers
• protect vulnerable populations.

Justice also requires consideration of community health alongside individual needs.

Balancing Individual Rights and Public Health

One of the most challenging ethical issues in infection prevention is balancing individual freedoms with the protection of others.

Examples include:

• postponing therapy due to infectious illness
• implementing visitor restrictions
• modifying group programs
• requiring PPE in healthcare settings
• changing service delivery to telehealth during outbreaks.

Occupational Therapists should ensure restrictions are:

• evidence-based
• proportionate
• time-limited where possible
• clearly communicated
• regularly reviewed.

The least restrictive option that adequately manages risk should always be considered.

Ethical Decision-Making Frameworks

Ethical dilemmas rarely have simple solutions.

A structured approach supports consistent and transparent decision-making.

An ethical decision-making process may include:

1. Identify the ethical issue.
2. Gather relevant clinical and contextual information.
3. Identify the stakeholders involved.
4. Consider applicable legislation, policies and professional standards.
5. Review available evidence.
6. Evaluate possible options.
7. Select and implement the most appropriate course of action.
8. Reflect on the outcome and document the clinical reasoning.

Using a systematic framework promotes fairness, consistency and accountability.

Professional Boundaries

Professional boundaries protect both clients and practitioners.

Occupational Therapists should:

• practise within scope
• avoid providing advice outside their expertise
• maintain therapeutic relationships
• recognise limitations
• refer appropriately
• seek supervision when required.

Infection prevention decisions should always remain within the practitioner’s professional competence.

Professional Accountability

Professional accountability requires Occupational Therapists to accept responsibility for their professional conduct.

This includes:

• maintaining competence
• practising ethically
• following evidence-based guidelines
• documenting decisions
• reporting hazards
• recognising limitations
• participating in continuing professional development
• engaging in reflective practice.

Accountability extends beyond individual client encounters and includes contributing to organisational quality improvement and public confidence in the profession.

Ethical Considerations for Assistance Animals

Occupational Therapists working alongside assistance animals may encounter additional ethical considerations.

Examples include:

• balancing client independence with infection prevention
• supporting animal welfare during healthcare interventions
• determining when veterinary referral is appropriate
• maintaining appropriate hygiene without compromising the working relationship between handler and animal
• advocating for reasonable adjustments while protecting public health.

Decisions should consider:

• client wellbeing
• disability rights
• animal welfare
• public safety
• organisational requirements.

The One Health framework encourages consideration of these interconnected interests rather than viewing them as competing priorities.

Managing Ethical Conflict

Disagreement may arise between clients, families, healthcare professionals or organisations regarding infection prevention decisions.

When conflict occurs, Occupational Therapists should:

• communicate respectfully
• clarify concerns
• review available evidence
• consider ethical principles
• consult organisational policies
• seek interdisciplinary input
• access ethics consultation where available
• document decision-making.

Respectful dialogue often supports collaborative solutions while maintaining therapeutic relationships.

The Occupational Therapist’s Role

Occupational Therapists demonstrate ethical practice by:

• integrating ethical principles into clinical reasoning
• balancing individual and community interests
• supporting informed decision-making
• advocating for equitable access to care
• practising within scope
• maintaining professional accountability
• considering disability rights and animal welfare
• documenting ethical reasoning
• applying One Health principles when managing infection prevention challenges.

Ethical practice strengthens trust, supports person-centred care and promotes safe, inclusive and evidence-informed occupational therapy.

Key Practice Principle

Ethical decision-making requires Occupational Therapists to balance infection prevention with respect for autonomy, justice, beneficence and non-maleficence. By applying structured ethical reasoning, maintaining professional accountability and considering the interconnected health of people, assistance animals and the environment, Occupational Therapists support safe, equitable and person-centred infection prevention practice within a One Health framework.