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A Missed Moment for Ethical Reflection—and a Concerning Signal About Governance

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During today’s AOTA Representative Assembly meeting, the vote to approve the consent agenda passed 55–0 . Included in that consent agenda was a substantial revision to our Code of Ethics —and not one representative moved to pull it for open discussion . Yes, the revisions were reviewed in a task group. Yes, there was a comment period. But those procedural steps, while technically fulfilled, do not substitute for meaningful public deliberation —especially on something so foundational. The Code of Ethics is not just a policy; it reflects the core of our professional identity . When we alter that framework—particularly in ways that introduce a distinct set of social or philosophical assumptions—we should do so through visible, intentional, and inclusive ethical dialogue . That did not happen here. Members reached out. Emails were sent. Concerns were raised. But nothing was pulled. No one spoke. In the lead-up to the vote, I publicly stated the following: “I invite those who helped shape...
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The Ant Mill of Occupational Therapy: A Profession Trapped in Its Own Spiral

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Being in program development mode has given me both the time and headspace to think more deeply about some of the broader dynamics shaping our profession. The release of AOTA’s newly published Vision Statement and the proposed changes to the Code of Ethics have provided a catalyst for deeper reflection. Ethics in occupational therapy can feel distant or overly academic—something shaped by committees and frameworks rather than day-to-day practice. I’m someone who has worn both hats—a street-level OT who’s spent too much time in academia—and that gives me a particular vantage point for reflecting on where we’ve been and where we might be headed. I’m writing this for the lunch-bucket practitioners out there—the ones grounded in clinical realities—who have sensed that something in our professional dialogue feels increasingly unfamiliar or prescribed. But I think we need to bring these conversations down to earth. We need to pull chairs into a circle, metaphorically speaking, and talk thr...
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When Theory Ignores the Shower Chair

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Philosophical thinking has always had value in occupational therapy. It helps us understand the deeper meanings of occupation, the ethics of care, and the cultural assumptions that shape our practice. But philosophy becomes a problem when it detaches from the reality of patient care. Take one example: I once worked with a patient who was Native American and had diabetes complicated by years of substance abuse. He was blind and had bilateral above-knee amputations. His family had limited resources and limited support. They were doing the best they could. And so was I. My plan of care was entirely rooted in his problems—because that's what brought occupational therapy into the picture in the first place. Clinicians don’t have the luxury of deconstructing outcome measures when they’re in a cramped living space, trying to help someone who can’t get into a shower. Rather, they are working with families who are struggling to care for their loved ones under impossible conditions. Tha...
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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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