Standards of practice, professional conduct, and ethics
Domain 4 tests professional standards: competence, honesty, boundaries, and patient-centered conduct. Ethics questions usually turn on the least self-serving, most transparent action.
Core rules
- Practice within scope and competence; use evidence-informed methods; refer when the problem is outside OT.
- Obtain and document informed consent; respect refusal and the right to stop treatment.
- Maintain professional boundaries. Sexual or exploitative relationships with patients are prohibited; gifts and dual relationships require judgment and documentation.
- Protect confidentiality, except as authorized or required by law.
- Document accurately and contemporaneously; never alter a record to hide an error. Correct errors with a dated addendum.
- Collaborate with the team, but do not let another provider pressure you into unsafe or out-of-scope care.
- Report suspected abuse/neglect and comply with Board reporting duties; do not abandon patients.
Worked example
A long-term patient offers an expensive watch as thanks. The OT declines politely, explains the boundary, and documents the offer and response. Reasoning: accepting a high-value gift can exploit the therapeutic relationship and create bias; a token gift may be handled under employer policy, but the safe exam answer is decline and document.
Traps
Choosing “protect the facility” over patient safety; accepting gifts because refusal is awkward; altering notes after an incident; and confusing personal values with professional obligations.