ETHICS

AOTA 2020 Occupational Therapy

Code of Ethics

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Preamble

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 (AOTA, 2020).

The Code is an AOTA Official Document and a public compliance with these Principles and is a manifestation
statement tailored to address the most prevalent ethical of moral character and mindful reflection. Adherence
concerns of the occupational therapy profession. It sets to the Code is a commitment to benefit others, to the
forth Core Values and outlines Standards of Conduct virtuous practice of artistry and science, to genuinely
the public can expect from those in the profession. The good behaviors, and to noble acts of courage. Recog-
1
Code applies to all occupational therapy personnel in all nizing and resolving ethical issues is a systematic process
areas of occupational therapy and should be shared with that includes analyzing the complex dynamics of situa-
relevant stakeholders to promote ethical conduct. tions, applying moral theories and weighing alternatives,
The Code serves two purposes:
making reasoned decisions, taking action, and reflecting
1. It provides aspirational Core Values that guide oc- on outcomes. Occupational therapy personnel are ex-
cupational therapy personnel toward ethical courses of
pected to abide by the Principles and Standards of
action in professional and volunteer roles.
Conduct within this Code.
2. It delineates ethical Principles and enforceable
The process for addressing ethics violations by AOTA
Standards of Conduct that apply to AOTA members.
members (and associate members,2 where applicable) is
Whereas the Code helps guide and define decision- outlined in the Code’s Enforcement Procedures (AOTA,
making parameters, ethical action goes beyond rote 2019).
1
The term occupational therapy personnel in this document includes occupational therapist and occupational therapy assistant practitioners and
professionals (e.g., direct service, consultation, administration); educators; students in occupational therapy and occupational therapy assistant
professional programs; researchers; entrepreneurs; business owners; and those in elected, appointed, or other professional volunteer service.
2
For a definition of associate members, please see the AOTA website: https://www.aota.org/AboutAOTA/Membership/Types-and-Fees.aspx

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ETHICS

Although many state regulatory boards incorporate the values, beliefs, or lifestyles that differ from their own.
Code or similar language regarding ethical behavior into Equality applies to the professional arena as well as to
regulations, the Code is meant to be a freestanding recipients of occupational therapy services.
document that guides ethical dimensions of professional 3. Freedom indicates valuing each person’s right to
behavior, responsibility, practice, and decision making. exercise autonomy and demonstrate independence,
This Code is not exhaustive; that is, the Principles and initiative, and self-direction. A person’s occupations play
Standards of Conduct cannot address every possible a major role in their development of self-direction, ini-

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situation. Therefore, before making complex ethical de- tiative, interdependence, and ability to adapt and relate
cisions that require further expertise, occupational therapy to the world. Occupational therapy personnel affirm the
personnel should seek out resources to assist with re- autonomy of each individual to pursue goals that have
solving conflicts and ethical issues not addressed in this personal and social meaning. Occupational therapy
document. Resources can include, but are not limited to, personnel value the service recipient’s right and desire
ethics committees, organizational ethics officers or con- to guide interventions.
sultants, and the AOTA Ethics Commission. For a full list of 4. Justice indicates that occupational therapy personnel
AOTA ethics resources, please refer to the AOTA website provide occupational therapy services for all persons
at https://www.aota.org/Practice/Ethics.aspx. in need of these services and maintain a goal-
Appendix A describes the revision process for the directed and objective relationship with recipients of
2020 Code. Appendix B summarizes the history of the service. Justice places value on upholding moral and
AOTA Occupational Therapy Code of Ethics. legal principles and on having knowledge of and
respect for the legal rights of recipients of service.
Occupational therapy personnel must understand
Core Values
and abide by local, state, and federal laws governing
The occupational therapy profession is grounded in seven professional practice. Justice is the pursuit of a state
longstanding Core Values: Altruism, Equality, Freedom, in which diverse communities are inclusive and are
Justice, Dignity, Truth, and Prudence (AOTA, 1993). The organized and structured so that all members can
seven Core Values provide a foundation to guide oc- function, flourish, and live a satisfactory life regard-
cupational therapy personnel in their interactions with less of age, gender identity, sexual orientation, race,
others. These Core Values should be considered when religion, origin, socioeconomic status, degree of
determining the most ethical course of action (adapted ability, or any other status or attributes. Occupational
from Core Values and Attitudes of Occupational Therapy therapy personnel, by virtue of the specific nature of
Practice; AOTA, 1993): the practice of occupational therapy, have a vested
1. Altruism indicates demonstration of unselfish concern interest in social justice: addressing unjust inequities
for the welfare of others. Occupational therapy per- that limit opportunities for participation in society
sonnel reflect this concept in actions and attitudes of (Ashe, 2016; Braveman & Bass-Haugen, 2009). They
commitment, caring, dedication, responsiveness, and also exhibit attitudes and actions consistent with
understanding. occupational justice: full inclusion in everyday
2. Equality indicates that all persons have fundamental meaningful occupations for persons, groups, or
human rights and the right to the same opportunities. populations (Scott et al., 2017).
Occupational therapy personnel demonstrate this value 5. Dignity indicates the importance of valuing, promoting,
by maintaining an attitude of fairness and impartiality and preserving the inherent worth and uniqueness of
and treating all persons in a way that is free of bias. each person. This value includes respecting the person’s
Personnel should recognize their own biases and re- social and cultural heritage and life experiences.
spect all persons, keeping in mind that others may have Exhibiting attitudes and actions of dignity requires

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occupational therapy personnel to act in ways consistent remove harm (Doherty & Purtilo, 2016). Examples
with cultural sensitivity, humility, and agility. of Beneficence include protecting and defending
6. Truth indicates that occupational therapy personnel in the rights of others, preventing harm from occurring
all situations should be faithful to facts and reality. to others, removing conditions that will cause harm
Truthfulness, or veracity, is demonstrated by being to others, offering services that benefit persons with
accountable, honest, forthright, accurate, and au- disabilities, and acting to protect and remove persons
thentic in attitudes and actions. Occupational therapy from dangerous situations (Beauchamp & Childress,

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personnel have an obligation to be truthful with 2019).
themselves, recipients of service, colleagues, and
society. Truth includes maintaining and upgrading Principle 2. Nonmaleficence
professional competence and being truthful in oral, Occupational therapy personnel shall refrain from actions
written, and electronic communications. that cause harm.
7. Prudence indicates the ability to govern and discipline The Principle of Nonmaleficence indicates that occu-
oneself through the use of reason. To be prudent is to pational therapy personnel must refrain from causing
value judiciousness, discretion, vigilance, moderation, harm, injury, or wrongdoing to recipients of service.
care, and circumspection in the management of one’s Whereas Beneficence requires taking action to incur
own affairs and to temper extremes, make judgments, benefit, Nonmaleficence requires avoiding actions that
and respond on the basis of intelligent reflection and cause harm (Beauchamp & Childress, 2019). The
rational thought. Prudence must be exercised in clinical Principle of Nonmaleficence also includes an obligation
and ethical reasoning, interactions with colleagues, not to impose risks of harm even if the potential risk is
and volunteer roles. without malicious or harmful intent. This Principle is
often examined in the context of due care, which
requires that the benefits of care outweigh and justify
Principles
the risks undertaken to achieve the goals of care
The Principles guide ethical decision making and inspire (Beauchamp & Childress, 2019). For example, an oc-
occupational therapy personnel to act in accordance cupational therapy intervention might require the service
with the highest ideals. These Principles are not hi- recipient to invest a great deal of time and perhaps even
erarchically organized. At times, conflicts between discomfort; however, the time and discomfort are jus-
competing principles must be considered in order to tified by potential long-term, evidence-based benefits of
make ethical decisions. These Principles may need to the treatment.
be carefully balanced and weighed according to pro-
fessional values, individual and cultural beliefs, and Principle 3. Autonomy
organizational policies. Occupational therapy personnel shall respect the right of
the person to self-determination, privacy, confidentiality,
Principle 1. Beneficence and consent.
Occupational therapy personnel shall demonstrate a The Principle of Autonomy expresses the concept
concern for the well-being and safety of persons. that occupational therapy personnel have a duty to
The Principle of Beneficence includes all forms of action treat the client or service recipient according to their
intended to benefit other persons. The term beneficence desires, within the bounds of accepted standards of
has historically indicated acts of mercy, kindness, and care, and to protect their confidential information.
charity (Beauchamp & Childress, 2019). Beneficence Often, respect for Autonomy is referred to as the
requires taking action to benefit others—in other self-determination principle. Respecting the Autonomy
words, to promote good, to prevent harm, and to of service recipients acknowledges their agency,

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including their right to their own views and opinions includes fostering understanding of such information.
and their right to make choices in regard to their own Veracity is based on the virtues of truthfulness, candor,
care and based on their own values and beliefs honesty, and respect owed to others (Beauchamp &
(Beauchamp & Childress, 2019). For example, persons Childress, 2019). In communicating with others, occu-
have the right to make a determination regarding pational therapy personnel implicitly promise to be
care decisions that directly affect their lives. In the event truthful and not deceptive. For example, when entering
that a person lacks decision-making capacity, their into a therapeutic or research relationship, the

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Autonomy should be respected through the involvement service recipient or research participant has a right to
of an authorized agent or surrogate decision accurate information. In addition, transmission of
maker. information must include means to ensure that the
recipient or participant understands the information
Principle 4. Justice provided.
Occupational therapy personnel shall promote equity,
inclusion, and objectivity in the provision of occupational Principle 6. Fidelity
therapy services. Occupational therapy personnel shall treat clients
The Principle of Justice relates to the fair, equitable, (persons, groups, or populations), colleagues, and other
and appropriate treatment of persons (Beauchamp & professionals with respect, fairness, discretion,
Childress, 2019). Occupational therapy personnel and integrity.
demonstrate attitudes and actions of respect, inclusion, The Principle of Fidelity refers to the duty one has to
and impartiality toward persons, groups, and pop- keep a commitment once it is made (Veatch et al., 2015).
ulations with whom they interact, regardless of age, This commitment refers to promises made between a
gender identity, sexual orientation, race, religion, ori- provider and a client, as well as maintenance of
gin, socioeconomic status, degree of ability, or any other respectful collegial and organizational relationships
status or attributes. Occupational therapy personnel (Doherty & Purtilo, 2016). Professional relationships
also respect the applicable laws and standards are greatly influenced by the complexity of the
related to their area of practice. Justice requires the environment in which occupational therapy personnel
impartial consideration and consistent observance of work. For example, occupational therapy personnel
policies to generate unbiased decisions. For example, should consistently balance their duties to service
occupational therapy personnel work to create and recipients, students, research participants, and
uphold a society in which all persons have equitable other professionals, as well as to organizations
opportunity for full inclusion in meaningful occupational that may influence decision making and professional
engagement as an essential component of their practice.
lives.

Principle 5. Veracity
Standards of Conduct
Occupational therapy personnel shall provide
comprehensive, accurate, and objective information The AOTA Ethics Commission, under the Enforcement
when representing the profession. Procedures for the AOTA Occupational Therapy Code of
The Principle of Veracity refers to comprehensive, ac- Ethics (AOTA, 2019), enforces the Standards of Conduct
curate, and objective transmission of information and listed in Table 1.

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Table 1. Standards of Conduct for Occupational Therapy Personnel

Section Standards of Conduct

1. Professional Integrity, Responsi- 1A. Comply with current federal and state laws, state scope of practice guidelines, and
bility, and Accountability: Occupa- AOTA policies and Official Documents that apply to the profession of occupational
tional therapy personnel maintain therapy. (Principle: Justice; key words: policy, procedures, rules, law, roles, scope
awareness and comply with AOTA of practice)
policies and Official Documents, 1B. Abide by policies, procedures, and protocols when serving or acting on behalf of a
current laws and regulations professional organization or employer to fully and accurately represent the orga-

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that are relevant to the profession nization’s official and authorized positions. (Principle: Fidelity; key words: policy,
of occupational therapy, and procedures, rules, law, roles, scope of practice)
employer policies and procedures. 1C. Inform employers, employees, colleagues, students, and researchers of applicable
policies, laws, and Official Documents. (Principle: Justice; key words: policy,
procedures, rules, law, roles, scope of practice)
1D. Ensure transparency when participating in a business arrangement as owner,
stockholder, partner, or employee. (Principle: Justice; key words: policy, proce-
dures, rules, law, roles, scope of practice)
1E. Respect the practices, competencies, roles, and responsibilities of one’s own and
other professions to promote a collaborative environment reflective of interpro-
fessional teams. (Principle: Fidelity; key words: policy, procedures, rules, law, roles,
scope of practice, collaboration, service delivery)
1F. Do not engage in illegal actions, whether directly or indirectly harming stakeholders
in occupational therapy practice. (Principle: Justice; key words: illegal, unethical
practice)
1G. Do not engage in actions that reduce the public’s trust in occupational therapy.
(Principle: Fidelity; key words: illegal, unethical practice)
1H. Report potential or known unethical or illegal actions in practice, education, or
research to appropriate authorities. (Principle: Justice; key words: illegal, unethical
practice)
1I. Report impaired practice to the appropriate authorities. (Principle: Nonmaleficence;
key words: illegal, unethical practice)
1J. Do not exploit human, financial, or material resources of employers for personal
gain. (Principle: Fidelity; key words: exploitation, employee)
1K. Do not exploit any relationship established as an occupational therapy practitioner,
educator, or researcher to further one’s own physical, emotional, financial, political,
or business interests. (Principle: Nonmaleficence; key words: exploitation, aca-
demic, research)
1L. Do not engage in conflicts of interest or conflicts of commitment in employment,
volunteer roles, or research. (Principle: Fidelity; key words: conflict of interest)
1M. Do not use one’s position (e.g., employee, consultant, volunteer) or knowledge
gained from that position in such a manner as to give rise to real or perceived
conflict of interest among the person, the employer, other AOTA members, or other
organizations. (Principle: Fidelity; key words: conflict of interest)
1N. Do not barter for services when there is the potential for exploitation and conflict of
interest. (Principle: Nonmaleficence; key words: conflict of interest)
1O. Conduct and disseminate research in accordance with currently accepted ethical
guidelines and standards for the protection of research participants, including
informed consent and disclosure of potential risks and benefits. (Principle: Be-
neficence; key words: research)
2. Therapeutic Relationships: Occu- 2A. Respect and honor the expressed wishes of recipients of service. (Principle: Au-
pational therapy personnel develop tonomy; key words: relationships, clients, service recipients)
therapeutic relationships to promote 2B. Do not inflict harm or injury to recipients of occupational therapy services, students,
occupational well-being in all persons, research participants, or employees. (Principle: Nonmaleficence; key words: rela-
groups, organizations, and society, tionships, clients, service recipients, students, research, employer, employee)
(Continued )

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Table 1. Standards of Conduct for Occupational Therapy Personnel (cont’d)

Section Standards of Conduct

regardless of age, gender identity, 2C. Do not threaten, manipulate, coerce, or deceive clients to promote compliance with
sexual orientation, race, religion, ori- occupational therapy recommendations. (Principle: Autonomy; key words: rela-
gin, socioeconomic status, degree of tionships, clients, service recipients)
ability, or any other status or 2D. Do not engage in sexual activity with a recipient of service, including the client’s
attributes. family or significant other, while a professional relationship exists. (Principle:
Nonmaleficence; key words: relationships, clients, service recipients, sex)

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2E. Do not accept gifts that would unduly influence the therapeutic relationship or have
the potential to blur professional boundaries, and adhere to employer policies when
offered gifts. (Principle: Justice; key words: relationships, gifts, employer)
2F. Establish a collaborative relationship with recipients of service and relevant
stakeholders to promote shared decision making. (Principle: Autonomy; key words:
relationships, clients, service recipients, collaboration)
2G. Do not abandon the service recipient, and attempt to facilitate appropriate transitions
when unable to provide services for any reason. (Principle: Nonmaleficence; key
words: relationships, client, service recipients, abandonment)
2H. Adhere to organizational policies when requesting an exemption from service to an
individual or group because of self-identified conflict with personal, cultural, or
religious values. (Principle: Fidelity; key words: relationships, client, service re-
cipients, conflict, cultural, religious, values)
2I. Do not engage in dual relationships or situations in which an occupational therapy
professional or student is unable to maintain clear professional boundaries or
objectivity. (Principle: Nonmaleficence; key words: relationships, clients, service
recipients, colleagues, professional boundaries, objectivity, social media)
2J. Proactively address workplace conflict that affects or can potentially affect pro-
fessional relationships and the provision of services. (Principle: Fidelity; key words:
relationships, conflict, clients, service recipients, colleagues)
2K. Do not engage in any undue influences that may impair practice or compromise the
ability to safely and competently provide occupational therapy services, education,
or research. (Principle: Nonmaleficence; key words: relationships, colleagues,
impair, safety, competence, client, service recipients, education, research)
2L. Recognize and take appropriate action to remedy occupational therapy personnel’s
personal problems and limitations that might cause harm to recipients of service.
(Principle: Nonmaleficence; key words: relationships, clients, service recipients,
personal, safety)
2M. Do not engage in actions or inactions that jeopardize the safety or well-being of
others or team effectiveness. (Principle: Fidelity; key words: relationships, clients,
service recipients, colleagues, safety, law, unethical, impaired, competence)
3. Documentation, Reimbursement, 3A. Bill and collect fees justly and legally in a manner that is fair, reasonable, and
and Financial Matters: Occupational commensurate with services delivered. (Principle: Justice; key words: billing, fees)
therapy personnel maintain complete, 3B. Ensure that documentation for reimbursement purposes is done in accordance with
accurate, and timely records of all applicable laws, guidelines, and regulations. (Principle: Justice; key words: docu-
client encounters. mentation, reimbursement, law)
3C. Record and report in an accurate and timely manner and in accordance with ap-
plicable regulations all information related to professional or academic documen-
tation and activities. (Principle: Veracity; key words: documentation, timely,
accurate, law, fraud)
3D. Do not follow arbitrary directives that compromise the rights or well-being of others,
including unrealistic productivity expectations, fabrication, falsification, plagiarism
of documentation, or inaccurate coding. (Principle: Nonmaleficence; key words:
productivity, documentation, coding, fraud)
(Continued )

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Table 1. Standards of Conduct for Occupational Therapy Personnel (cont’d)

Section Standards of Conduct

4. Service Delivery: Occupational 4A. Respond to requests for occupational therapy services (e.g., referrals) in a timely
therapy personnel strive to deliver manner as determined by law, regulation, or policy. (Principle: Justice; key words:
quality services that are occupation occupational therapy process, referral, law)
based, client centered, safe, interac- 4B. Provide appropriate evaluation and a plan of intervention for recipients of occu-
tive, culturally sensitive, evidence pational therapy services specific to their needs. (Principle: Beneficence; key words:
based, and consistent with occupa- occupational therapy process, evaluation, intervention)

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tional therapy’s values and 4C. Use, to the extent possible, evaluation, planning, intervention techniques, as-
philosophies. sessments, and therapeutic equipment that are evidence based, current, and within
the recognized scope of occupational therapy practice. (Principle: Beneficence; key
words: occupational therapy process, evaluation, intervention, evidence, scope of
practice)
4D. Obtain informed consent (written, verbal, electronic, or implied) after disclosing
appropriate information and answering any questions posed by the recipient of
service, qualified family member or caregiver, or research participant to ensure
voluntary participation. (Principle: Autonomy; key words: occupational therapy
process, informed consent)
4E. Fully disclose the benefits, risks, and potential outcomes of any intervention; the
occupational therapy personnel who will be providing the intervention; and any
reasonable alternatives to the proposed intervention. (Principle: Autonomy; key
words: occupational therapy process, intervention, communication, disclose, in-
formed consent)
4F. Describe the type and duration of occupational therapy services accurately in
professional contracts, including the duties and responsibilities of all involved
parties. (Principle: Veracity; key words: occupational therapy process, intervention,
communication, disclose, informed consent, contracts)
4G. Respect the client’s right to refuse occupational therapy services temporarily or
permanently, even when that refusal has potential to result in poor outcomes.
(Principle: Autonomy; key words: occupational therapy process, refusal, inter-
vention, service recipients)
4H. Provide occupational therapy services, including education and training, that are
within each practitioner’s level of competence and scope of practice. (Principle:
Beneficence; key words: occupational therapy process, services, competence,
scope of practice)
4I. Reevaluate and reassess recipients of service in a timely manner to determine
whether goals are being achieved and whether intervention plans should be revised.
(Principle: Beneficence; key words: occupational therapy process, reevaluation,
reassess, intervention)
4J. Terminate occupational therapy services in collaboration with the service recipient
or responsible party when the services are no longer beneficial. (Principle: Be-
neficence; key words: occupational therapy process, termination, collaboration)
4K. Refer to other providers when indicated by the needs of the client. (Principle:
Beneficence; key words: occupational therapy process, referral, service recipients)
4L. Provide information and resources to address barriers to access for persons in need
of occupational therapy services. (Principle: Justice; key words: beneficence, ad-
vocate, access)
4M. Report systems and policies that are discriminatory or unfairly limit or prevent
access to occupational therapy. (Principle: Justice; key words: discrimination,
unfair, access, social justice)
4N. Provide professional services within the scope of occupational therapy practice
during community-wide public health emergencies as directed by federal, state, and
local agencies. (Principle: Beneficence; key words: disasters, emergency)
(Continued )

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Table 1. Standards of Conduct for Occupational Therapy Personnel (cont’d)

Section Standards of Conduct

5. Professional Competence, 5A. Hold requisite credentials for the occupational therapy services one provides in
Education, Supervision, and academic, research, physical, or virtual work settings. (Principle: Justice; key words:
Training: Occupational therapy credentials, competence)
personnel maintain credentials, 5B. Represent credentials, qualifications, education, experience, training, roles, duties,
degrees, licenses, and other competence, contributions, and findings accurately in all forms of communication.
certifications to demonstrate their (Principle: Veracity; key words: credentials, competence)

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commitment to develop and maintain 5C. Take steps (e.g., professional development, research, supervision, training) to
competent, evidence-based practice. ensure proficiency, use careful judgment, and weigh potential for harm when
generally recognized standards do not exist in emerging technology or areas of
practice. (Principle: Beneficence; key words: credentials, competence)
5D. Maintain competence by ongoing participation in professional development relevant
to one’s practice area. (Principle: Beneficence; key words: credentials, competence)
5E. Take action to resolve incompetent, disruptive, unethical, illegal, or impaired practice
in self or others. (Principle: Fidelity; key words: competence, law)
5F. Ensure that all duties delegated to other occupational therapy personnel are con-
gruent with their credentials, qualifications, experience, competencies, and scope of
practice with respect to service delivery, supervision, fieldwork education, and
research. (Principle: Beneficence; key words: supervisor, fieldwork, supervision,
student)
5G. Provide appropriate supervision in accordance with AOTA Official Documents and
relevant laws, regulations, policies, procedures, standards, and guidelines. (Prin-
ciple: Justice; key words: supervisor, fieldwork, supervision, student)
5H. Be honest, fair, accurate, respectful, and timely in gathering and reporting fact-based
information regarding employee job performance and student performance.
(Principle: Veracity; key words: supervisor, supervision, fieldwork, performance)
5I. Do not participate in any action resulting in unauthorized access to educational
content or exams, screening and assessment tools, websites, and other copyrighted
information, including but not limited to plagiarism, violation of copyright laws, and
illegal sharing of resources in any form. (Principle: Justice; key words: plagiarize,
student, copyright, cheating)
5J. Provide students with access to accurate information regarding educational re-
quirements and academic policies and procedures relative to the occupational
therapy program or educational institution. (Principle: Veracity; key words: edu-
cation, student)
6. Communication: Whether in writ- 6A. Maintain the confidentiality of all verbal, written, electronic, augmentative, and
ten, verbal, electronic, or virtual nonverbal communications in compliance with applicable laws, including all aspects
communication, occupational therapy of privacy laws and exceptions thereto (e.g., Health Insurance Portability and Ac-
personnel uphold the highest stan- countability Act, Family Educational Rights and Privacy Act). (Principle: Autonomy;
dards of confidentiality, informed key words: law, autonomy, confidentiality, communication, justice)
consent, autonomy, accuracy, timeli- 6B. Maintain privacy and truthfulness in delivery of occupational therapy services,
ness, and record management. whether in person or virtually. (Principle: Veracity; key words: telecommunication,
telehealth, confidentiality, autonomy)
6C. Preserve, respect, and safeguard private information about employees, colleagues,
and students unless otherwise mandated or permitted by relevant laws. (Principle:
Fidelity; key words: communication, confidentiality, autonomy)
6D. Demonstrate responsible conduct, respect, and discretion when engaging in digital
media and social networking, including but not limited to refraining from posting
protected health or other identifying information. (Principle: Autonomy; key words:
communication, confidentiality, autonomy, social media)
6E. Facilitate comprehension and address barriers to communication (e.g., aphasia;
differences in language, literacy, health literacy, or culture) with the recipient of
(Continued )

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Table 1. Standards of Conduct for Occupational Therapy Personnel (cont’d)

Section Standards of Conduct

service (or responsible party), student, or research participant. (Principle: Auton-
omy; key words: communication, barriers)
6F. Do not use or participate in any form of communication that contains false,
fraudulent, deceptive, misleading, or unfair statements or claims. (Principle: Ve-
racity; key words: fraud, communication)
6G. Identify and fully disclose to all appropriate persons any errors or adverse events that

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compromise the safety of service recipients. (Principle: Veracity; key words:
truthfulness, communication, safety, clients, service recipients)
6H. Ensure that all marketing and advertising are truthful, accurate, and carefully
presented to avoid misleading recipients of service, research participants, or the
public. (Principle: Veracity; key words: truthfulness, communication)
6I. Give credit and recognition when using the ideas and work of others in written, oral,
or electronic media (i.e., do not plagiarize). (Principle: Veracity; key words: truth-
fulness, communication, plagiarism, students)
6J. Do not engage in verbal, physical, emotional, or sexual harassment of any individual
or group. (Principle: Fidelity; key words: inappropriate communication, harassment,
digital media, social media, social networking, professional civility)
6K. Do not engage in communication that is discriminatory, derogatory, biased, in-
timidating, insensitive, or disrespectful or that unduly discourages others from
participating in professional dialogue. (Principle: Fidelity; key words: inappropriate
communication, professionalism, professional civility)
6L. Engage in collaborative actions and communication as a member of interprofes-
sional teams to facilitate quality care and safety for clients. (Principle: Fidelity; key
words: communication, collaboration, interprofessional, professional civility, service
recipients)
7. Professional Civility: Occupational 7A. Treat all stakeholders professionally and equitably through constructive en-
therapy personnel conduct themselves gagement and dialogue that is inclusive, collaborative, and respectful of diversity
in a civil manner during all discourse. of thought. (Principle: Justice; key words: civility, diversity, inclusivity, equitability,
Civility “entails honoring one’s per- respect)
sonal values, while simultaneously 7B. Demonstrate courtesy, civility, value, and respect to persons, groups, organizations,
listening to disparate points of view” and populations when engaging in personal, professional, or electronic commu-
(Kaslow & Watson, 2016, para. 1). nications, including all forms of social media or networking, especially when that
These values include cultural sensi- discourse involves disagreement of opinion, disparate points of view, or differing
tivity and humility. values. (Principle: Fidelity; key words: values, respect, opinion, points of view, social
media, civility)
7C. Demonstrate a level of cultural humility, sensitivity, and agility within professional
practice that promotes inclusivity and does not result in harmful actions or inactions
with persons, groups, organizations, and populations from diverse backgrounds
including age, gender identity, sexual orientation, race, religion, origin, socioeco-
nomic status, degree of ability, or any other status or attributes. (Principle: Fidelity;
key words: civility, cultural competence, diversity, cultural humility, cultural
sensitivity)
7D. Do not engage in actions that are uncivil, intimidating, or bullying or that contribute
to violence. (Principle: Fidelity; key words: civility, intimidation, hate, violence,
bullying)
7E. Conduct professional and personal communication with colleagues, including
electronic communication and social media and networking, in a manner that is free
from personal attacks, threats, and attempts to defame character and credibility
directed toward an individual, group, organization, or population without basis or
through manipulation of information. (Principle: Fidelity; key words: civility, culture,
communication, social media, social networking, respect)

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Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics

References (8th ed.). Oxford University Press.
Braveman, B., & Bass-Haugen, J. D. (2009). Social justice and health dis-
American Occupational Therapy Association. (1993). Core values and
parities: An evolving discourse in occupational therapy research and
attitudes of occupational therapy practice. American Journal of Oc-
intervention. American Journal of Occupational Therapy, 63, 7–12.
cupational Therapy, 47, 1085–1086. https://doi.org/10.5014/ajot.47.12.
https://doi.org/10.5014/ajot.63.1.7
1085
Doherty, R., & Purtilo, R. (2016). Ethical dimensions in the health professions
American Occupational Therapy Association. (2019). Enforcement proce-
(6th ed.). Elsevier Saunders.
dures for the AOTA Occupational Therapy Code of Ethics. American

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Kaslow, N. J., & Watson, N. N. (2016). Civility: A core component
Journal of Occupational Therapy, 73(Suppl. 2), 7312410003. https://doi.
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org/10.5014/ajot.2019.73S210
American Occupational Therapy Association. (2020). Occupational therapy apa.org/ed/precollege/ptn/2016/09/civility-professionalism
practice framework: Domain and process (4th ed.). American Journal of Scott, J. B., Reitz, S. M., & Harcum, S. (2017). Principle 4: Justice. In J. B. Scott
Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10. & S. M. Reitz (Eds.), Practical applications for the Occupational Therapy
5014/ajot.2020.74S2001 Code of Ethics (2015) (pp. 85–95). AOTA Press.
Ashe, A. (2016). Social justice and meeting the needs of clients. In D. Y. Slater Veatch, R. M., Haddad, A. M., & English, D. C. (2015). Case studies in
(Ed.), Reference guide to the Occupational Therapy Code of Ethics biomedical ethics: Decision-making, principles, and cases (2nd ed.).
(2015 Edition). AOTA Press. Oxford University Press.

Authors
Ethics Commission Members, 2019–20 and 2020–21
Brenda S. Howard, DHSc, OTR, Ethics Chairperson, 2019–2023
Leslie Bennett, OTD, OTR/L, Member at Large, 2019–2021
Brenda Kennell, MA, OTR/L, FAOTA, Education Representative, 2015–2021
Kimberly S. Erler, PhD, OTR/L, Practice Representative, 2014–2020
Barbara Elleman, MHS, OTD, OTR/L, Practice Representative, 2020–2023
Jan Keith, BA, COTA/L, OTA Representative, 2017–2020
Marita Hensley, COTA/L, OTA Representative, 2020–2023
Donna Ewy, MD, FAAFP, MTS, Public Member, 2019–2022
Roger A. Ritvo, PhD, Public Member, 2018–2021
Mark Franco, Esq., Legal Counsel
Rebecca E. Argabrite Grove, MS, OTR/L, FAOTA, AOTA Ethics Program Manager
Revised by the AOTA Ethics Commission, 2020

Adopted by the Representative Assembly, November 2020

Note. This revision replaces the 2015 document Occupational Therapy Code of Ethics (2015), previously published and copyrighted in 2015 by
the American Occupational Therapy Association in the American Journal of Occupational Therapy, 69, 6913410030. https://doi.org/10.5014/ajot.
2015.696S03

Copyright © 2020 by the American Occupational Therapy Association.

Citation. American Occupational Therapy Association. (2020). AOTA 2020 occupational therapy code of ethics. American Journal of Occu-
pational Therapy, 74(Suppl. 3), 7413410005. https://doi.org/10.5014/ajot.2020.74S3006

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Appendix A. 2020 Revision Process for the

AOTA 2020 Occupational Therapy Code of Ethics
In Fall 2019, the Ethics Commission (EC) of the American Occupational Therapy Association (AOTA) began the
process of reviewing the Occupational Therapy Code of Ethics (the Code) as part of the AOTA Representative
Assembly’s 5-year review cycle. Although ethical principles are timeless, the issues to which they apply and the manner
of application are constantly evolving, as are the health care and community environments in which occupational

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therapy personnel apply them. Therefore, the Code must change to remain applicable to the environments in which
occupational therapy personnel work. The following paragraphs outline the changes made to the 2015 Code.
From August to November 2019, EC members reviewed codes of ethics from several health care professions and
found that the organization of codes of ethics documents and online platforms had evolved. These professions had
organized their codes not by bioethical principles, but by their relationship to areas of practice and professionalism.
Moreover, the professions had organized their online platforms for greater interactive agility. The EC decided that a
major revision of the Code’s organization was in order, although the majority of the content would remain unchanged.
EC members divided into work groups to reorganize the Code by dividing the 2015 Code into the following parts:
Preamble, Core Values, Principles, Standards of Conduct, and Appendixes.
EC work group members reorganized the Standards of Conduct from the 2015 Code into behavioral categories. The
work group reviewed and discussed the placement of the Standards until consensus was reached. The work group then
presented the reorganization of the Standards to the full EC for discussion on February 25, 2020. The EC continued to
review and reorganize the standards until June 9, 2020. The EC added a section on Professional Civility in response to a
referred motion from the Representative Assembly. Once completed and reviewed on June 9, the EC sent the revised
Code draft to content experts for further review and edits.
Content experts completed a survey for responding to changes in the Code using both Likert-type scale ratings and
open-ended responses. The EC reviewed the feedback from the content experts on July 14, 2020, and incorporated
revisions to create a draft of the Code for membership review.
In July and August 2020, the EC sent a survey to all AOTA members to garner feedback on the revised Code. Results
of the survey indicated that among the 122 respondents to the survey, there was 80% or greater agreement that each
part of the Code was both relevant and clear. EC members compiled qualitative feedback, carefully considered
comments, and made edits to complete the final draft of the Code. The EC then submitted this final draft of the Code, and
accompanying motion and rationale, to the Representative Assembly in September 2020. After online discussion, the
Representative Assembly voted on November 4, 2020, to pass the motion to strike the Occupational Therapy Code of
Ethics (2015) and replace it with the AOTA 2020 Occupational Therapy Code of Ethics.

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Appendix B. History of the AOTA Occupational Therapy Code of Ethics

As society evolves, so must our understanding and implementation of ethical practices as occupational therapy
personnel. The American Occupational Therapy Association (AOTA) 2020 Occupational Therapy Code of Ethics (the
Code) continues to be a critical tool in the AOTA Ethics Commission’s quest to guide ethical conduct and elevate public
trust in the profession. The Code must be a dynamic, living document that grows and develops to complement changes
in occupational therapy delivery models, technology, and society.

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The first official AOTA ethical code was established in 1975. Work to create this document, titled “Principles of
Ethics,” began in 1973. Carolyn Baum, Carlotta Welles, Larry Peak, Lou Arents, and Carole Hayes authored this
document. At that time, many professional associations began creating codes of ethics in response to the ethical issues
being raised by the Tuskegee Syphilis Study, in which researchers studied the effects of syphilis on African-American
men who had not given informed consent and were told that they were being treated for the disease (Centers for Disease
Control and Prevention, 2016). The outcry after the public became aware of this violation, even after standards had been
put in place after World War II and the Nuremberg Code of 1947, led many professions to establish ethics rules.
In April 1977, the AOTA Representative Assembly approved the “Principles of Occupational Therapy Ethics,” and
AOTA distributed them in the American Journal of Occupational Therapy in November 1977. This first publicly cir-
culated rendition of the Code of Ethics consisted of 12 principles, all starting with the words “Related to,” such as
“Related to the Recipient of Service.”
The Code of Ethics underwent revisions in 1988, 1994, 2000, 2005, 2010, 2015, and 2020, with input from AOTA
membership. The 1988 revision began to look like the modern Code, with headings called “Principles” and subheadings
called “Standards.” In 1994, the members of the AOTA Ethics Commission added a focus on bioethical principles rather
than professional behaviors, as in the previous two editions. The Principles included in the 1994 Code were Benef-
icence; Autonomy, Privacy, and Confidentiality; Duty; Justice; and Fidelity and Veracity. The Principle of Non-
maleficence was added in 2000, and Social Justice was added in 2010, then combined with the Principle of Justice in
2015.
There were 30 Standards of Conduct in 2000; this number increased to 38 in 2005 and to 77 in 2010, then decreased
to 69 in 2015. These Standards, categorized under the various Principles, were expanded to promote ethical practice in
a variety of areas, including the use of technology for telehealth, social media, Internet use, and health records. With the
2020 Code revision, the EC has grouped the revised 73 Standards of Conduct by behaviors rather than under the
Principles, in order to return to the original concept of relating the Standards to desired professional behaviors, so that
they are more easily accessible to the membership when using the Code. As charged by the Representative Assembly,
the Ethics Commission added a section on Professional Civility in 2020.
The Representative Assembly mandates that the Code, as an official AOTA policy document, undergo review every 5
years. This continual review is especially important because some states use the AOTA Code as part of their licensure
acts. In addition, some states require occupational therapy practitioners to obtain continuing education in ethics in order
to maintain licensure. In updating the Code to meet the needs of members and society, the occupational therapy
profession continues to reflect and lead change in health care.

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References for Appendixes A and B

American Occupational Therapy Association. (1977). 1977 Representative American Occupational Therapy Association. (2005). Occupational therapy
Assembly—Resolution A, Principles of occupational therapy ethics. code of ethics (2005). American Journal of Occupational Therapy, 59,
American Journal of Occupational Therapy, 31, 594. 639–642. https://doi.org/10.5014/ajot.59.6.639
American Occupational Therapy Association. (1988). Occupational therapy American Occupational Therapy Association. (2010). Occupational therapy
code of ethics. American Journal of Occupational Therapy, 42, 795–796. code of ethics and ethics standards (2010). American Journal of Oc-
https://doi.org/10.5014/ajot.42.12.795 cupational Therapy, 64(Suppl.), S17–S26. https://doi.org/10.5014/ajot.

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American Occupational Therapy Association. (1994). Occupational therapy 2010.64S17
code of ethics. American Journal of Occupational Therapy, 48, American Occupational Therapy Association. (2015). Occupational
1037–1038. https://doi.org/10.5014/ajot.48.11.1037 therapy code of ethics (2015). American Journal of Occupational Therapy,
American Occupational Therapy Association. (2000). Occupational therapy 69 (Suppl 3), 6913410030. https://doi.org/10.5014/ajot.2015.696S03
code of ethics (2000). American Journal of Occupational Therapy, 54, Centers for Disease Control and Prevention. (2016). U.S. Public Health Service
614–616. https://doi.org/10.5014/ajot.54.6.614 syphilis study at Tuskegee. http://www.cdc.gov/tuskegee/timeline.htm

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