Reflecting on the AOTA Code of Ethics: A 2025 Crossroads

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 blurring of aspirational values with enforceable standards—a logic problem that threatens the functional integrity of the Code.

  • Aspirational values such as advocacy, equity, or cultural humility are designed to inspire excellence—not to serve as conditions for disciplinary action.
  • Enforceable standards must be clear, objective, and universally applicable.
Embedding aspirations like “challenging inequitable power dynamics” or “reporting systemic discrimination” into enforceable sections introduces serious risks:
  • Confusion about what is encouraged vs. required.
  • Exposure to professional sanction for ideological nonconformity.
  • Suppression of pluralism and viewpoint diversity within the profession.
  • Legal vulnerability for ambiguous or overly broad ethical mandates.
Professional ethics should protect the public and unify the profession—not become a litmus test for cultural alignment. Unfortunately, the current revisions risk turning that ideal on its head.

Equality vs. Equity: A Philosophical Shift with Practical Consequences

One of the most consequential changes in the revised Code is the replacement of equality with equity as a core value. This is not a minor semantic revision—it reflects a fundamental philosophical shift.

  • Equality emphasizes treating all individuals with fairness, impartiality, and consistency under shared rules and professional standards.
  • Equity, by contrast, requires professionals to account for individual differences in identity, background, and circumstance—and to tailor treatment and resources accordingly.
While the intent behind equity is often noble, its inclusion as an enforceable ethical standard raises serious problems:
  • It is subjective and context-dependent, making it nearly impossible to operationalize with consistency.
  • It invites differential treatment based primarily on identity categories, which may conflict with principles of autonomy and justice as traditionally understood.
  • It obscures the therapist’s role as a clinician, transforming ethical expectations into social engineering.
  • It risks undermining trust between practitioners and clients who may not share or understand these philosophical premises.
Ethical standards must be grounded in clear, actionable principles. Elevating equity to a mandatory ethical framework imposes a contested worldview on the profession without a clear consensus—and without due regard for the practical realities of occupational therapy practice.

I addressed a related concern in a 2013 post in which I examined whether social justice provisions added to the Code had ever been cited in actual disciplinary cases (Alterio, 2013). My findings showed no evidence of such enforcement at that time, raising concerns about the transparency, utility, and enforceability of broad aspirational principles within the Code. That gap between ethical ideals and professional regulation remains highly relevant today.

Revisiting a Decade of Concern

These aren’t new concerns for me. In fact, I raised them in 2011 when the term "social justice" was introduced into the Code without sufficient definitional clarity or consensus on its application to occupational therapy (Alterio, 2011). I cautioned then that embedding broad political ideals into enforceable ethics posed a risk to intellectual diversity.

In 2014, I critiqued what I called the "fourth paradigm"—a trend of replacing client-centered clinical care with abstract, deconstructive narratives aimed at advancing ideological causes (Alterio, 2014a). That shift, I warned, was turning occupational therapy into a platform for diffuse social activism at the expense of professional clarity and identity.

That same year, I also raised concerns about the trend of introducing new core values into the profession without grounding them in historical or conceptual foundations (Alterio, 2014b). Drawing from the origins of the profession in the Emmanuel Movement, I argued that our ethical framework should evolve deliberately and with reference to the values that shaped our identity. Randomly adding new values—no matter how fashionable—risks destabilizing the coherence and enforceability of the entire Code.

In 2015, I reiterated that we were already “in trouble when our code of ethics becomes a place for political expression” (Alterio, 2015).

Unfortunately, the 2025 revisions appear to confirm that trajectory. What began as an aspirational gesture has now solidified into enforceable directives, transforming professional ethics into a tool of ideological enforcement.

Other Emerging Concerns

  1. Politicized Language – Terms like “systemic oppression” and “identity-based disparities” reflect one political worldview. Ethics codes should be ideologically neutral.
  2. Suppression of Pluralism – Ethical standards that embed cultural mandates stifle diversity of thought and penalize reasonable disagreement.
  3. Mission Creep – Embedding advocacy into enforceable standards assigns therapists roles far beyond the clinical scope, diluting professional identity.
  4. Vagueness and Ambiguity – Ethics codes should clarify, not confuse. Many of the proposed revisions rely on vague, subjective language.
A Way Forward

  • Reestablish a clear boundary between aspirational values and enforceable standards.
  • Ground the Code in timeless ethical principles: autonomy, beneficence, nonmaleficence, fidelity, veracity, and classically defined justice.
  • Recognize that ethical diversity is not a threat but a strength.
  • Ensure enforceable standards are written in clear, objective terms.
Closing Thoughts

The AOTA Code of Ethics should unify the profession—not divide it. It should inspire ethical excellence without imposing ideological uniformity. I hope this moment will prompt deeper reflection and a recommitment to the foundational principles that have long guided our profession.


References:

Alterio, C. (2011). 2011 Social Justice Debates in Occupational Therapy. ABC Therapeutics. https://abctherapeutics.blogspot.com/2011/12/2011-social-justice-debates-in.html

Alterio, C. (2013). Social Justice Follow Up: Brass Tacks for the Occupational Therapy Profession. ABC Therapeutics. https://abctherapeutics.blogspot.com/2013/01/social-justice-follow-up-brass-tacks.html

Alterio, C. (2014a). Pushing Back Against the Fourth Paradigm in the Occupational Therapy Profession. ABC Therapeutics. https://abctherapeutics.blogspot.com/2014/11/pushing-back-against-fourth-paradigm-in.html

Alterio, C. (2014b). Emmanuelism Provided the Core Values to the Developing Occupational Therapy Profession. ABC Therapeutics. https://abctherapeutics.blogspot.com/2014/05/emmanuelism-provided-core-values-to.html

Alterio, C. (2015). Social Justice in Occupational Therapy: Where to from here? ABC Therapeutics. https://abctherapeutics.blogspot.com/2015/05/social-justice-in-occupational-therapy.html


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