Ethics, Governance, and the Role of the Practitioner: A Follow-Up

A few months ago, I submitted a formal petition to AOTA expressing concern about the approval of the revised Code of Ethics through a consent agenda. I questioned whether it was appropriate to pass a foundational document that defines the ethical framework of the profession without open deliberation or engagement with members.

I was invited to present my concerns to a Review Committee. The process was respectful. The committee listened attentively and expressed gratitude to me for my engagement. Today, I received word that the consent agenda vote to approve the Code would not be reconsidered and that there was no violation of AOTA bylaws. However, AOTA acknowledged that future governance and member education needed to be strengthened such that the governance team developed targeted educational strategies to support volunteer leaders in their understanding of how to use consent agendas. In sum, they affirmed the procedural decision while offering a commitment to improved the process moving forward.

I see this as a measure of progress. It is a recognition that process matters, and that transparency is worth talking about. 

Unfortunately, even though Administrative SOP VII(D) discourages controversial or significant issues from being bundled into consent agendas unless there is full agreement or non-controversy - it happened anyway. So we have to take next steps.

Now we shift to the next phase of the conversation. In many states, the AOTA Code of Ethics is adopted by reference into law or regulation. That means that when AOTA makes changes, (no matter how those changes were passed) those changes may become enforceable at the state level without further review or input. This has implications for all practitioners, regardless of whether they are even AOTA members. Accordingly, if we are not having the robust conversations that we need to have within our professional meetings, we can bring those conversations to our state licensing boards.

For those who have expressed concern about the shift in the Code’s ethical emphasis, particularly the replacement of equality with equity, it is important to understand what this means at the regulatory level. And more importantly, it is time to take meaningful action.

What Practitioners Can Do

1. Review your state’s practice act and regulations.
Look for language that adopts or references the AOTA Code of Ethics. This may appear under definitions, standards of conduct, or disciplinary rules. You are looking for whether the Code is explicitly named and whether a specific version is cited or if “the current Code” is referenced.

2. Determine how updates are handled.
Some states reference a fixed edition, such as the 2015 Code. Others simply say “the AOTA Code of Ethics,” which implies automatic adoption of future versions. If your state does not independently review and adopt updated Codes, then changes made by AOTA become enforceable without further oversight.

3. Ask your board for clarification.
You can write a brief, respectful letter or email to your licensing board and ask:

• What version of the Code is currently enforced?

• How does the board review future changes to the Code?

• Are there opportunities for licensee input when ethical standards are revised?

Even if you do not receive a direct reply, these questions place the issue on the board’s radar.

4. Request specific regulatory language.
If your state currently adopts the Code automatically, request a change such as:

“The AOTA Code of Ethics is adopted by reference. Future revisions shall not be enforceable unless formally reviewed and adopted by the board.”

This small clarification can preserve transparency and due process.

5. Speak up, even if your state is unlikely to respond.
I live and practice in New York. It is unlikely that in my state I would find a sympathetic ear related to the equity and equality language. Still, even though a single letter from a practitioner will not lead to immediate regulatory reform, silence will always be read as consent. Raising the issue contributes to broader awareness. It lets other practitioners know they are not alone. It sends a signal to our regulators that we are engaged and attentive. And it creates a public record that can matter when these issues are reviewed later.

In other states, particularly where legislative interest in curbing or reviewing equity-based mandates is already active, there may be a greater likelihood of finding sympathetic ears. This is especially true where lawmakers are scrutinizing professional regulations that embed contested ideological language without public input.

If AOTA will not guarantee an open discussion on a Code that shifts foundational language, we can have the conversation at the state level instead. The question of how ethics is framed, whether through principles of fairness and equality or equity and identity-based outcomes, is not just philosophical. It is practical, enforceable, and profession-defining.

6. Invite others to join you.
You do not need a large coalition. Even a small group of practitioners submitting a shared letter can carry weight. A short, coordinated statement that affirms pluralism, transparency, and stable ethics shows that the conversation is active and ongoing. It encourages others to step forward.

Moving Forward

The goal of this work is stewardship. Ethical codes matter. They influence how we relate to patients, to one another, and to the broader public. They should reflect our shared professional commitments and should be developed through open, pluralistic discussion.

When our Code was more firmly rooted in classical ethical frameworks with principles like autonomy, beneficence, justice, fidelity I had no quarrel. That didn’t mean I agreed with every board decision or interpretation, but we shared a foundation. There was at least a common language and grounding for disagreement.

Now we no longer have that shared framework. The revised Code introduces a shift that is replacing equality with equity, and that shift was not openly debated before being adopted. The consent agenda approach precluded meaningful dialogue, and while I appreciate that AOTA plans to educate members and volunteers about governance processes in the future, we already have an Administrative SOP that discourages bundling significant or controversial matters into consent agendas. That guidance was not followed in this case.

With no clear internal path for review, the next phase of this conversation needs to take place at the state level. Fortunately, many state licensing bodies are careful not to incorporate external documents that change without oversight. That gives practitioners a chance to reintroduce deliberation, especially around frameworks that define misconduct, that guide self-regulation, and shape how the profession earns public trust.

This isn’t the path I would have chosen. But it now seems necessary, and I am always up for a good conversation.

AOTA could have simply stated, 'We did not follow our own administrative procedures" and then had the vote re-cast. There is a decent chance that we would have the same result, but with a deliberative process in place one can't argue the outcome. One can be dissatisfied, but one can't argue. But we never had the deliberative process, and in my view we violated the SOP, so now we can have a deliberative process at a different level.

I don't believe that AOTA benefits from 1, or 5, or 50, or 100, or  however many practitioners  contacting their state licensing boards to raise procedural concerns about the Code of Ethics and the absence of deliberative process. Time and capital could be better spent doing other things. But here we are.

If you would like help drafting a letter to your licensing board or gathering resources to share with colleagues, I am happy to assist. I’ll continue to share updates as this effort develops.