RUNING HEAD: MENTORSHIP REFLECTION PAPER 3: ETHICAL DILEMMAS

Mentorship Reflection Paper 3: Ethical Dilemmas

1000487430

University of Toronto – St. George Campus

OCT 1190

Erin Lawson

January 10, 2020

RUNING HEAD: MENTORSHIP REFLECTION PAPER 3: ETHICAL DILEMMAS

Ethical dilemmas are rife within the healthcare sector and are situations that I am bound

to experience in my future practice as an occupational therapist (OT). In one of my previous

placements on a Palliative Care unit, I observed an instance in which my preceptor faced an

ethical dilemma. After a couple of weeks with a client, my preceptor and I discovered that an

elderly client of ours was a victim of elder abuse. We found out through a discussion with the

client’s concerned daughter, during which the client expressed fear over the possibility of her

son—the client’s formal Power of Attorney (PoA)—finding out that she and her daughters had

been talking to us about her abuse. The client’s anxieties had reached to a point where she had

become visibly distressed.

Throughout the interaction, I found myself feeling both angry and devastated at what I

was hearing. The goal of Palliative Care is to, as much as possible, help a client pass away in

comfort. I was angry about how the client was being treated by her PoA and devastated over the

thought that she was living out her last days in fear and distress.

Furthermore, the client had immigrated to Canada during her senior years to take care of

her grandchildren. In our Older Adults class, we learned about how the intersectionality between

immigration and age can pose even more occupational challenges and distress for clients. I

thought about how difficult it must have been for my client to leave behind her friends, family,

and resources that she accumulated in Greece to immigrate to Canada. There have been various

research studies investigating the perceptions of older adult immigrants, which highlight the

sense of loneliness, dependency, and helplessness they feel after immigration due to linguistic

and cultural isolation as well as intergenerational tension. Reflecting on this research, I was even

more angered thinking about everything that the client left behind only to immigrate here and
RUNING HEAD: MENTORSHIP REFLECTION PAPER 3: ETHICAL DILEMMAS

experience abuse from a family member. I thought of my own parents and how, I would have

wanted them to spend their last days in peace rather than in fear.

With this in mind, I remember leaving the client’s room, eager to speak with my OT

preceptor about what our next steps would be. You can imagine my surprise and internal turmoil

when my preceptor informed me that there was not much that we could do for the client except

to debrief with the unit manager. She also mentioned that we must be conscious of what details

we include in the client’s progress note from a liability perspective. Unfortunately, my placement

was over before finding out the outcomes of the discussion. However, I was able to debrief with

my preceptor prior to leaving.

In reflecting on my debrief with my preceptor, I realized that there were a couple of

considerations that my preceptor brought into the dilemma. First, I believe that she brought in

her past experience of a similar situation. She recounted an instance in which she reported elder

abuse brought on by her client’s PoA that did not turn out well for her— ultimately, the PoA

retracted consent to have her continue seeing the client and her employer had reprimanded her.

My preceptor may have considered the consequences that reporting the PoA would have had,

professionally and therapeutically. This experience affects her approach with this client. She also

brought in her knowledge of the legal system—the complexities of assigning a new PoA and the

strain it would have put on her and her family—and the client’s limited days into consideration;

She asked to me, “How helpful would it be for the client spend her last days going through all

the legal proceedings required to change her POA?”

Currently, I remain unsettled with how the situation turned out. I believe that my

preceptor managed the situation in the best way that she could, taking her professional

experience into account. I am unsettled because I would have liked to do more for this client.
RUNING HEAD: MENTORSHIP REFLECTION PAPER 3: ETHICAL DILEMMAS

However, I still do not know what I could have done more as I had never experienced this kind

of ethical dilemma before; I do not know how arduous it would be on the client and family to

undergo the legalities of abuse and changing POAs. Thus, this ethical dilemma resulted from a

conflict between what I believed was morally right (i.e. to report abuse and forestall further

harm) and what may still be considered morally right given the end-of-life context (i.e. to refrain

from reporting abuse to avoid excess strain and further harm on the client and family in the

client’s last few days).

In conclusion, I learned many things about OT practice from this event. First, I learned

the importance of recognizing intersectionality and how it impacts a client’s experience as well

as my perception of their experience, which impacts my clinical decision-making. I also learned

that there are many considerations that must be made when making decisions about a client’s

care and treatment—particularly, the practice context, client’s prognosis, and the possible

consequences that my decisions may have on the client, family, and practitioner. Lastly, I learned

that while I may see my clients often and consistently in my future practice, there is still so much

that I do not see about their lives: This highlights the importance of using various means of

information-gathering as a practitioner, as well as building strong rapport to establish trust.

Overall, I still do not feel prepared to deal with a similar situation in the future. With more

independence interacting with clients and other healthcare professionals in my future placements,

I hope to gain the skills that would better equip me to effectively manage a similar situation in

the future.