Introduction: Ethical decision-making is an important component of occupational therapy practice in Canada. Research is needed to understand ethical decision-making and how to build occupational therapists’ competency to make ethical decisions. Purpose: The aim of this thesis was to study ethical decision-making in occupational therapy practice in order to contribute to epistemological development regarding ethics in occupational therapy and to support continuing competency in ethical decision-making. Method: Three studies comprise this thesis. A constructivist grounded theory study was conducted involving in-depth semi-structured interviews with 18 occupational therapists from a range of practice settings to explore the process of ethical decision-making. An interpretive description study using secondary analysis of grounded theory data was conducted to explore gaps related to continuing competency in ethical decision-making from the participants’ perspective and to generate recommendations for future directions to support continuing competency. Finally, a non-randomized, single-group, pre- and post-test study (n=33) was conducted to evaluate an on-line education module developed to support competency for clinician-educators. Findings: The grounded theory study led to development of an ethical decision-making prism capturing three processes: Considering the Fundamental Checklist, Consulting Others, and Doing What’s Right. The interpretive description study highlighted two gaps related to continuing competency in ethical decision-making: lack of knowledge and lack of supports. Education, tool development, and ethics mentorship were identified directions for development. The third evaluation study found that an on-line education module led to improvements in ethics knowledge and intent to change practice but not to actual practice change. Implications: This thesis advances a theoretical understanding of ethical decision-making in occupational therapy practice and an applied understanding of occupational therapists’ needs related to competent ethical decision-making. Findings also provide preliminary data regarding on-line ethics education to advance knowledge and skills of clinician-educators who are involved in cultivating ethical decision-making among student occupational therapists. / Thesis / Doctor of Philosophy (PhD) / “Doing what’s right”, or ethical decision-making, is an important part of being an occupational therapist in Canada. To help occupational therapists build knowledge and skills it is important to understand how they make ethical decisions in day-to-day practice. This PhD describes three studies that look at three different aspects of ethical decision-making. The first study presents a theoretical explanation of how occupational therapists decide what’s right to do. The second study uses the same data to look at supports that occupational therapists feel they need to build knowledge and skills about ethical decision-making. The third study measures the value of an on-line education course in helping occupational therapy educators teach students about ethical decision-making. Results of these studies can be used to support occupational therapists in doing what’s right. Results also highlight areas for additional study to further support ethical occupational therapy practice in Canada.

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