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What Can We Learn from Maine? A Case Study in the Shifting Ethics of Occupational Therapy

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In my previous post, I raised concerns about the increasing use of politicized language in the AOTA Code of Ethics. I argued that terms like equity and justice—however well-intentioned—have taken on broad, contested meanings, and that their uncritical adoption into our profession’s foundational documents risks substituting moral clarity for ideological fashion. In further research, I’ve come across something worth examining in more detail: how the state of Maine handled two different versions of AOTA’s Code of Ethics—first in 2010, and then again in 2023. The difference between these two adoption events reveals a great deal about how professional ethics are evolving—not necessarily for the better. Maine in 2010: Ethical Caution In 2010, the Maine Board of Occupational Therapy adopted AOTA’s then-current Code of Ethics with exclusions. Specifically, they removed Principle 4: Social Justice, signaling that parts of the document were seen as extending beyond enforceable professional condu...
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Reflecting on the AOTA Code of Ethics: A 2025 Crossroads

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In light of the proposed 2025 revisions to the AOTA Code of Ethics, I feel compelled to respond—not just as a practitioner and educator, but as someone who has been observing and writing about the profession’s ethical evolution for over a decade. This post reflects on concerns raised in the new draft and situates them in a broader historical context drawn from earlier critiques I published in 2011, 2013, 2014, and 2015. When Ethics Become Ideology The proposed 2025 Code of Ethics contains well-meaning language that reflects cultural currents around equity, inclusion, and advocacy. However, the revised document appears to shift the Code away from its core purpose—guiding ethical behavior—and toward promoting a specific ideological framework. It contains language and assumptions that may unintentionally alienate practitioners, obscure clarity in enforcement, and conflate professional conduct with political conformity. A Critical Logic Problem The most serious concern is the...
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A Lenten Message: Memory, Tradition, and the Things That Endure

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I visited the grave of my great-grandfather in Pennsylvania last summer. I had only been there once before, as a child on a trip with my family, and I realized how little I knew about him. He immigrated to the United States with nothing, worked in a railroad foundry, and died at a very early age during the influenza epidemic. That is nearly all I know. When I arrived at the gravesite, I found a stone cross—once the top of his headstone—lying broken on the ground. It struck me then how fragile memory is, how easily the markers of a life can be worn away or broken over time. After my great-grandfather's death, the family moved to New York where my grandfather grew up. Following in his father’s footsteps, he worked for the railroad, but while he lived longer than his father, his life was still cut short at a relatively young age. I know some things about him—his love of family, of God, of bowling—but the stories are fragmented, incomplete. He died just two weeks after I was born, so I...
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Holding On and Letting Go: The Stories We Keep

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When I bought a vintage Narragansett beer tray on eBay, I thought I was just adding to my collection. But when the seller sent me a heartfelt note about how his mother kept that tray on her mantle for many years, I realized I had done something more—I had brought a piece of someone's past back home. That moment reinforced a deeper truth: collecting isn’t just about the things. It’s about the stories, the connections, and the shared history that comes with them. A similar thing happened with a Schreiber’s Manru Beer tray—a beautiful piece of Buffalo brewing history. The seller reached out, telling me that his father had kept it in his workshop down in Texas, and it had always been a meaningful part of his space. The seller was so happy to send it back to the Buffalo area, knowing that it was going to someone who would appreciate its history. That sense of belonging, of an object being right where it should be, is something I’ve seen time and again in collecting. Then, today, I had a...
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The Percentile Trap: How Misused Statistics Skew Fairness in Sports and Occupational Therapy

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Lately, the conversation around gender in athletics, education, and therapy has gotten a lot more complicated. Questions about fairness, biology, and statistical interpretation are at the heart of some heated debates—whether it's about competitive advantage in sports or access to essential services like therapy. While these issues might seem separate, they both hinge on a common problem: how statistics are used (or misused) to justify decisions. I recently came across a post from an athlete who was assigned male at birth but is now competing in women’s sports. This issue connects directly to occupational therapy because it highlights how statistical reasoning—whether in competition or clinical settings—can shape real-world opportunities. The athlete argued that their transition had led to an ‘equitable’ change in performance by comparing their high school results in men’s competitions to their current college results in women’s competitions. The key claim? Their relative standing w...
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A Fatal Flaw: Occupational Therapy’s Dependence on Mandates

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New York’s Bill A.5474 proposes expanding the role of occupational therapy in schools by requiring the state commissioner to issue a guidance memorandum on OT services, particularly in early intervention and mental health support. Additionally, it calls for regulatory changes to formally include OTs within pupil personnel services and establish qualifications for a “school occupational therapist.” On the surface, this appears to be a step forward in recognizing the value of OT beyond special education, but a closer examination reveals significant gaps. With no attached funding, no mandate for service expansion, and a reliance on bureaucratic implementation, this bill risks being more symbolic than substantive. Given the political climate of shifting federal education funding to the states, it’s worth asking: Is this bill a real investment in student services, or is it just another unfunded directive that leaves schools scrambling? One of the biggest blind spots in A.5474—and in occu...
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On Ideological Shifts in Occupational Therapy Education: Reflections on DEI and the Presidential Executive Order

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The Accreditation Council for Occupational Therapy Education (ACOTE) Standards have evolved over time, with the 2023 updates reflecting a continuation of a broader ideological trend in the profession. Specifically, these updates prioritize Diversity, Equity, and Inclusion (DEI) in ways that raise fundamental questions about the balance between professional accreditation requirements and academic freedom.  The 2018 Standards recognized diversity as an important foundation for occupational therapy education. While encouraging awareness of diversity issues, these standards avoided prescribing specific ideological frameworks. This approach respected the autonomy of educational institutions, allowing them to incorporate diversity as they deemed appropriate while maintaining space for academic freedom and intellectual diversity. In contrast, the 2023 Standards explicitly embed DEI principles, including equity and justice, as requirements for occupational therapy programs. Faculty are now...
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Should ACOTE have a global focus?

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I read the ACOTE Director's Update - January 2025 with interest as it reported new Vision, Mission, and Values statements for ACOTE as follows: VISION : Lead, innovate, and advance occupational therapy education in a global environment. MISSION : Support quality, inclusion, and innovation to advance entry-level occupational therapy education. VALUES : Quality; Innovation; Collaboration; Inclusion; Integrity. For reference, the previous ACOTE statements were: VISION : Committed to the establishment, promotion, and evaluation of standards of quality in occupational therapy education. To this end, ACOTE will lead in the development of effective collaborative partnerships with the communities of interest, both internal and external to the profession of occupational therapy, which are affected by its activities. MISSION : Ensures quality occupational therapy education by developing accreditation standards and verifying implementation to support the preparation of competent occupational...
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