Ethics-Decision Making Model (Stumbo)

Decision making model for ethical situations:

The Decision-Making Model Ethical Situations in Professional Practice/Business
-Norma Stumbo, ATRA 1998

Identify Behavior

Elderly women who has advanced dementia and is a high fall risk desired to participate in
a nature walk. CTRS is unsure if she is cognitively or physically able to make a healthy
decision to participate and self-govern herself with her medical condition of advance
dementia during the group intervention.
Professional Relevance

Patients autonomy to make a decision is at question. The concern for the autonomy of an
individuals competence or capacity to understand the consequences of a particular task
or value their decision making. The judgment of who is able to make the decisions for the
individual is hard because the competence of the person may be incompetent one day and
competent the next.

Considerations:
American Therapeutic Recreation Association Code of Ethics
PRINCIPLE 2: AUTONOMY
- Therapeutic Recreation personnel have a duty to preserve and protect the right of each
individual to make his/her own choices. Each individual is to be given the opportunity to
determine his/her own course of action in accordance with a plan freely chosen.

Differentiate Personal and/or Professional Ideals and Values

Professional-
The safest or most cautious option is the best choice when working with long-term care
patients and when assessing if a patient is able to participate in the program. When the
patient is unable to make a decision based off their medical condition the healthcare
professional should make the best medical decision.
The CTRS job is to provide inclusive recreational activities and intervention programs for
all participants to help increase quality of life and well-being.
RT should work with the interdisciplinary team to determine the best option regarding the
safety and wellbeing of the patient and provide a holistic approach of care to the patient
when making a decision of participating.

Personal-
Not allowing someone to participate in a Recreational Therapy intervention falls on the
CTRS who is implementing the program. The interventions need to have an activity
analysis that will analyze the program and make considerations so all can participate. The
CTRS needs to adjust the intervention to be inclusive and prepare a way that the activity
can be safe for all those who want to participate, regardless of their abilities.
Recreational activities can have extra staff involved so the patient could have someone
monitoring her safety closer, to prevent an accident, allowing participation.
Ethics-Decision Making Model (Stumbo)

The job of a CTRS is to provide inclusive recreation to help increase the well-being of a
patient. The autonomy of a patient is very important to consider when providing a holistic
treatment.

Consider Legal Duties

The possibility of patient falling and causing severe harm and injury is a risk and liability
to the Recreational Therapist. The judgment of who gets to make medical decisions for
the person with dementia is the ability of the person to understand the purpose, risks,
benefits and alternatives of the treatment.
Patient needs to appreciate that she has a choice and understands the medial situation,
prognosis, nature of the recommended care, the risks and benefits of each and the
consequences according to the Alzheimer association on respect for autonomy.
(www.alz.org)

Principles:
Assume capacity unless there is evidence to suggest otherwise.
Dont assume the person lacks capacity simply because they make an unusual or
unwise decision.
The person has a right to be supported to make his or her own decision/s and
communicate the decision/s before it is assumed capacity to do so is lacking.

Any decision or action taken on behalf of the person must:
Benefit the person and be in their best interests
Restrict the persons freedom only so far as it is necessary to gain the benefit needed
Take account of his or her past and present views, wishes, values and beliefs
Take account of the views of relevant others (as specified in legislation)
Encourage the person to use his or her abilities and develop new skills.
(www.nuffieldfoundation.org)

Assess Ethical Obligations

At what point does being cautious impair the ability to perform the job requirements of a
CTRS and prevent treatment from occurring?
At what point is it more important to honor the patients autonomy and let them make a
decision then to take a risk and increase preventive measures to keep them safe?
When does the medical professional have the right to make a decision for a patient with a
mental illness? When does the medical professional allow for the patient to make her own
decisions regarding appropriate treatment?
How advanced does ones medical treatment have to be for their autonomy to be given
up? If patients autonomy is given up who is allowed to make decisions for the patient and
with what motives and guidelines?

ATRA Code of Ethics:
The American Therapeutic Recreation Associations Code of Ethics is to be used as a
guide for promoting and maintaining the highest standards of ethical behavior. The Code
applies to all Recreational Therapy personnel. The term Recreational Therapy personnel
includes Certified Therapeutic Recreation Specialists (CTRS), recreational therapy
Ethics-Decision Making Model (Stumbo)

assistants and recreational therapy students. Acceptance of membership in the American
Therapeutic Recreation Association commits a member to adherence to these principles.

Ethical Obligations:
Make sure the patient is making a decision that will keep her safe and healthy.
Respect the patients wishes and autonomy as much as possible.
Consider the health and well-being of others participating in the program and their safety.
Make sure the decision made is going to help improve patients quality of life.

Determine Action

Include the patient in the nature walk intervention and respect their autonomy of wanting
to participate.

o The patient is a high fall risk and wonders, she will need to have a staff worker paired
with her to ensure her safety and the safety of the others participating in the group.
o The Recreational Therapist will need to ensure that the nature walk is something that
this patient is capable of doing and if not, find an alternative route that would allow
for the patient to be safe during the intervention. Also, the CTRS should consider if a
wheelchair or walker could be used during the walk to help support the patient.
o The goal and purpose of the intervention must be written out so the client understands
why they are participating and documented so the intervention shows that there is
therapeutic purpose and reason to the walk.
o CTRS should have written consent from the patient that they are asking to participate
in the event and in the case of any injury, it was against medical advice for them to
participate. This ensures that fault wont fall on the CTRS or any other medical
professionals. This is crucial, because of the patients dementia, there needs to be
written documentation to help protect both the RT, the facility and the patient.