The beneficence of being beneficent (or its good to be good).

My attention was called to the principle of Beneficence this weekend in one of the discussions on the Accreditation Council for Occupational Therapy Education (ACOTE) mandate to move to a single point of entry at the doctoral level for the occupational therapist by 2027. A simple definition of beneficence is the act of doing good, active goodness, kindness or charity (http://www.dictionary.com/browse/beneficenceretrieved April 14, 2018). 

The principle was cited in response to a discussion I started on whether eliminating two points of entry for the OT in the US is an issue of justice. Despite thinking myself a strong social justice advocate proponent (I would proudly wear the badge of “social justice warrior!”) I don’t think that moving to a single point of entry is an issue of social injustice. I use the term social justice because I do not think that the term occupational justice has sufficiently been defined as a unique construct distinct from social justice.

I care about the justice issue because I have been dismayed by some of the comments I have read and heard. I appreciate that the OTD discussion has raised strong feelings and emotions but expressions that those who support the move to a single point of entry have abandoned principles of social (occupational) justice and the implication that they must not “care” as much as others bothers me. I am concerned over the creation of animus that will be counterproductive and destructive to our profession’s future.

After reading some thoughtful and instructive posts yesterday morning I spent some of my thinking time (which I do during grocery shopping and my 5 mile walk around our nearby park) considering what is means to “do good” and to “want good” in the context of the ACOTE mandate debate. 

It struck me that part of our challenge may be that people on both sides of the issue are acting out of a true sense of beneficence. People on both sides of the issue are concerned about doing good for our consumers, our current and future students, our practitioners and our other stakeholders. A problem arises when there are different carts and different horses and we disagree about which course of action will be most effective in achieving “good” for the most stakeholders while limiting negative consequences to the fullest extent possible.
 
There are likely many types of good that most of us would support although some are at odds with others. A non-exhaustive list might these include: 

• It is good for our profession and our consumers that we have a more diverse work force.
• It is good for our profession and our consumers to gradate students with the ability to evaluate and apply evidence at sophisticated levels in existing and emerging practice areas. 
• It is good for our profession and our consumers to support economically disadvantaged students to enter the profession.
• It is good for our profession and our consumers to assure a strong future for our profession by graduating students with sophisticated skills to succeed and lead in complex environments.
• It is good for our profession and our consumers to encourage practitioners educated abroad to move to the US to practice.
• It is good to limit student debt.
• It is good for our profession and our consumers to graduate students prepared to be independent practitioners who can problem solve and design interventions with limited supervision in environments with decreasing reimbursement and increased demands for productivity.
• It is good for our profession and our consumers for practitioners to understand the payoffs of value-based care for consumers, for organizations and for health care systems and to design and deliver highly effective and efficient intervention. 
• It is good for potential students, consumers, payers, state licensing boards and employers to understand what entry-level means and how new practitioners are educated and deemed competent.
• It is good to prepare competent entry-level practitioners, some of who will continue with training as research scientists to continue to develop our body of knowledge.

The principle of Beneficence is articulated in the AOTA Code of Ethics along with related Standards of Conduct. It is interesting to note that I do not think any of the Standards of Conduct apply to the discussion of entry-level requirements for our profession.

“BENEFICENCE 
Principle 1. Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. 
Beneficence includes all forms of action intended to benefit other persons. The term beneficence connotes acts of mercy, kindness, and charity (Beauchamp & Childress, 2013). Beneficence requires taking action by helping others, in other words, by promoting good, by preventing harm, and by removing harm. Examples of beneficence include protecting and defending the rights of others, preventing harm from occurring to others, removing conditions that will cause harm to others, helping persons with disabilities, and rescuing persons in danger (Beauchamp & Childress, 2013).

RELATED STANDARDS OF CONDUCT 
Occupational therapy personnel shall 

1. Provide appropriate evaluation and a plan of intervention for recipients of occupational therapy services specific to their needs. 
2. Reevaluate and reassess recipients of service in a timely manner to determine whether goals are being achieved and whether intervention plans should be revised. 
3. Use, to the extent possible, evaluation, planning, intervention techniques, assessments, and therapeutic equipment that are evidence based, current, and within the recognized scope of 
4. Ensure that all duties delegated to other occupational therapy personnel are congruent with credentials, qualifications, experience, competency, and scope of practice with respect to service delivery, supervision, fieldwork education, and research. 
5. Provide occupational therapy services, including education and training, that are within each practitioner’s level of competence and scope of practice. 
6. Take steps (e.g., continuing education, research, supervision, training) to ensure proficiency, use careful judgment, and weigh potential for harm when generally recognized standards do not exist in emerging technology or areas of practice. 
7. Maintain competency by ongoing participation in education relevant to one’s practice area. 
8. Terminate occupational therapy services in collaboration with the service recipient or responsible party when the services are no longer beneficial. 
9. Refer to other providers when indicated by the needs of the client. 
10. Conduct and disseminate research in accordance with currently accepted ethical guidelines and standards for the protection of research participants, including determination of potential risks and benefits (AOTA, 2015.”

In many of my blogs I seek to play with ideas as I go about trying to understand them and to apply them to daily life. There may be great flaws in my thinking here. I do not suggest it is fully developed, and hope that others, perhaps greater thinkers than I will help to develop this line of thought to lower the level of negative emotions in our community and to move toward productive and constructive action. 

Occupational Therapy Association. (2015). Occupational therapy code of ethics (2015). American Journal of Occupational Therapy, 69(Suppl. 3), 6913410030. http://dx.doi.org/10.5014/ajot.2015.696S03