Occupational therapy practitioners (OTPs) share a serious responsibility for upholding standards and ethical behavior. Our professional community regularly interacts with clients, families, caregivers, administrators, policymakers, and other health care professionals, and everyone deserves fair and just treatment.
Our behavior and level of professionalism reflect upon the entire community, and ethical conduct protects the reputation of occupational therapy, helping to expand and widen our ability to address clients’ challenges and contribute to a healthier society.
Great care has been taken to spell out the Core Values, ethical Principles, and enforceable Standards of Conduct that apply to AOTA members.
The Preamble to the Occupational Therapy Code of Ethics of the American Occupational Therapy Association reads:
“The 2020 Occupational Therapy Code of Ethics (The Code) of the American Occupational Therapy Association (AOTA) is designed to reflect the dynamic nature of the occupational therapy profession, the evolving health care environment, and emerging technologies that can present potential ethical concerns in practice, research, education and policy. AOTA members are committed to promoting inclusion, participation, safety, and well-being for all recipients of service in various stages of life, health and illness and to empowering all beneficiaries of service to meet their occupational needs. Recipients of services may be persons, groups, families, organizations, communities, or populations.”
What are some of the most pressing ethical issues in the profession? How are these challenges best addressed?
Common Ethical Issues in Occupational Therapy
Some common ethical issues in occupational therapy include confidentiality and privacy, ethical considerations in private practice, dual relationships, conflicts of interest, dealing with incompetence, and misleading patients.
In a 2022 study from the American Journal of Occupational Therapy, 125 early-career occupational therapists and certified occupational therapy assistants shared the top ethical challenges they faced. The most common concerns included issues with productivity and billing, providing quality care despite cost-cutting pressures, addressing care disparities linked to patients' financial situations, and experiencing moral distress in their therapeutic relationships.
The 2020 Occupational Therapy Code of Ethics (the Code) of AOTA provides a foundation for ethical practice. It includes Core Values and outlines ethical Principles and Standards of Conduct that apply to members of AOTA.
“Adherence to the Code is a commitment to benefit others, to the virtuous practice of artistry and science, to genuinely good behaviors, and to noble acts of courage,” the Code reads.
“Recognizing and resolving ethical issues is a systematic process that includes analyzing the complex dynamics of situations, applying moral theories, and weighing alternatives, making reasoned decisions, taking action, and reflecting on outcomes.”
Confidentiality and Privacy
Confidentiality is extremely important in health care, and it is the right of every patient, as stated in the Occupational Therapy Code of Ethics. Occupational therapy is subject to federal Health Insurance Portability and Accountability Act (HIPAA) rules and any additional state laws. The only exceptions to confidentiality exist when a patient’s safety is at risk, or the OTP believes that breaching confidentiality may prevent harm. There are also exceptions regarding suspected abuse, legal requirements to disclose information, and documenting communicable diseases.
The protection of clients’ private health information is one of the most important responsibilities of health care providers, and occupational therapy professionals need to protect sensitive information at all times. Principle 3 of the Code is titled Autonomy: “Occupational therapy personnel shall respect the right of the person to self-determination, privacy, confidentiality, and consent.”
In today’s world, confidentiality and privacy issues are complicated by the challenges that arise with digital record-keeping and telehealth. HIPAA rules specify which types of information must remain confidential.
Ethical Considerations in Private Practice
Confidentiality is extremely important in health care, and it is the right of every patient, as stated in the Occupational Therapy Code of Ethics. Occupational therapy is subject to federal Health Insurance Portability and Accountability Act (HIPAA) rules and any additional state laws. The only exceptions to confidentiality exist when a patient’s safety is at risk, or the OTP believes that breaching confidentiality may prevent harm. There are also exceptions regarding suspected abuse, legal requirements to disclose information, and documenting communicable diseases.
Ethical issues in private practice often stem from the dual roles played by the therapist as a business owner and a client advocate. These issues may include referrals, billing, third-party payer reimbursement, direct access, and continuity of care.
When financial needs conflict with client needs, ethical issues may arise. OTPs need to be aware of potential issues on the duration, type, and frequency of therapy, no matter who is paying for the therapy. Similarly, practice owners should use evidence-based resources to make decisions. They should not seek to maximize reimbursement or design approaches to increase profitability.
All OTPs are required to treat all patients without discrimination. Anyone who seeks occupational therapy should receive care, regardless of age, gender identity, sexual orientation, race, religions, origin, socioeconomic status, degree of ability, or other attributes. Principle 4 of the AOTA Code of Ethics is titled Justice: “Occupational therapy personnel shall promote equity, inclusion, and objectivity in the provision of occupational therapy services.
To set up an ethical structure for private practice, occupational therapy professionals should
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Become familiar with their state’s practice act law and administrative regulations that focus on conduct, including fraudulent activity, patient abuse, assisting another licensee in violating the practice act or regulation, falsifying documentation, or refusing to cooperate with an agency investigation.
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Review NBCOT’s Code of Conduct for ethical concerns that have an impact on certification.
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Explore AOTA’s Licensure page for resources on state requirements.
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Search AOTA's official documents for information on ethical questions regarding supervision or scope of practice.
Dealing with Incompetence
OTPs have an obligation to address incompetence when they encounter it in a team. The 2022 study of early career practitioners found that “OT practitioners who were in practice for more than one year reported experiencing significantly more ethical issues related to employer/employee and colleague relationships, including experiencing incompetent, unsafe, or unnecessary practice by a colleague.”
Incompetence reflects on the entire field of occupational therapy, and practitioners share a responsibility for addressing it, whether it involves inadequate skills or outdated practices. AOTA’s Ethics Commission provides education resources for members and consumers as well as handling complaints filed against past or present AOTA members. Note: This is not a legal process.
Misleading Patients
One of the Core Values of the AOTA Code of Ethics is Truth. The Code reads, “Occupational therapy personnel in all situations should be faithful to facts and reality. Truthfulness, or veracity, is demonstrated by being accountable, honest, forthright, accurate, and authentic in attitudes and actions.”
The AOTA Ethics FAQ offers detailed guidance on common ethical issues in occupational therapy. It addresses questions related to the updated Occupational Therapy Code of Ethics, the process for filing ethics complaints, and the roles of different regulatory bodies. Common ethical concerns discussed include:
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Confidentiality and when it can be breached
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Conflicts of interest
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Dual relationships and maintaining professional boundaries
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Ethical billing and payment practices
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Use of social media
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Ethical challenges in telehealth service delivery
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Professional conduct outside of work
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Ethical concerns in record keeping and documentation
Other issues that practitioners have reported include someone utilizing a modality for which they are not adequately trained, prolonging discharging the patient or discharging them too early, billing for unskilled treatment, and blurring the lines of personal and professional relationships.
Strategies to Address Ethical Issues
Ethical considerations weigh heavily in any profession, and AOTA is committed to providing education and resources for practitioners to create ethical workplace environments.
Education and Awareness
As lifelong learners, occupational therapy practitioners need to stay up to date with current ethical standards and principles. Ethics education is the key. Participants in the study of early career practitioners reported that ethics education aided them in making principled decisions. In particular, they found case studies, role playing and interprofessional education helpful as they built their careers.
AOTA’s ethics resources provide a blueprint for ethical conduct. No matter where you are in your career, it is a good idea to participate regularly in ethics training and revisit these online resources.
Ethical Workplaces
Colleagues can collaborate to create open workspaces where ethics can be discussed without fear of retaliation. Staff training and workshops can explore the AOTA Occupational Therapy Code of Ethics to create a shared language around ethical principles. Practitioners can find a community of support at conferences and events.
Finding Support
When it comes to ethical questions in practice, AOTA’s ethics resources provide examples of exemplary conduct, guiding principles, and the experience of seasoned practitioners who have witnessed a changing field.
A Healthy and Ethical Future
Ethical practice requires proactivity and positivity, and the ability to reflect on the Core Values in the Occupational Therapy Code of Ethics: Altruism, Equality, Freedom, Justice, Dignity, Truth, and Prudence.
For the ethical practitioner, resources are plentiful. This FAQ page is based on common ethics inquiries directed to AOTA’s Ethics Office. It explores the Occupational Therapy Code of Ethics, jurisdiction, complaints, confidentiality, and billing issues.
Occupational Therapy Code of Ethics provides a guidepost for ethical conduct from your first day of school until your final client walks out the door.
Additional AOTA Products for Further Learning
In line with the AOTA Code of Ethics, the book Everyday Ethics & Occupational Therapy aims to support occupational therapy practitioners in navigating ethical dilemmas and to equip students to handle daily ethical challenges. It includes foundational chapters along with new and updated Advisory Opinions from AOTA’s Ethics Commission.
If you’re looking for continuing education on ethics, the following courses are available for purchase (and included with AOTA Plus + and Premium memberships):
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Every Day Ethics: Core Knowledge for OT Practitioners and Educators, 4th edition
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Scope of Practice: Regulatory and Ethical Considerations, 3rd edition
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Ethics Topic—Duty to Warn: An Ethical Responsibility for All Practitioners, 3rd edition
