Episode 6: Equality's Out, Equity's In — But What Does That Mean for OT?

In this episode of Outspoken OT, Michelle Eliason examines one of the most significant changes introduced in the 2025 AOTA Code of Ethics: the replacement of equality with equity as a core value and the addition of advocacy as an ethical expectation for occupational therapy practitioners. Rather than reacting emotionally to these revisions, the episode takes a thoughtful, evidence-informed approach to understanding why these changes were made, what they signal about the future of the profession, and how they may influence clinical practice, education, research, and professional identity.

The episode begins by introducing listeners to the differences between the 2020 and 2025 Codes of Ethics, explaining why seemingly small changes in language can have significant downstream effects on clinical reasoning and ethical decision-making. Michelle discusses how professional ethics serve as more than guiding principles—they become the framework used by licensing boards, ethics commissions, educators, and practitioners to evaluate professional conduct. Understanding these revisions is essential for every occupational therapy practitioner, regardless of practice setting.

Building on that foundation, Michelle explores the conceptual shift from equality to equity, comparing the two side by side. The discussion examines how equality emphasizes impartial treatment and fairness in process, while equity focuses on achieving fair outcomes by recognizing and addressing barriers that prevent participation. Listeners are encouraged to consider how this shift changes the expectations placed on occupational therapists—not only in the way they deliver care, but also in how they identify barriers, adapt environments, and promote occupational participation beyond the treatment session.

The conversation then turns to the introduction of advocacy as a new core professional value. Michelle discusses both the opportunities and the challenges this presents, distinguishing between clinical advocacy that directly supports clients and broader systems-level advocacy aimed at organizational or legislative change. The episode explores where those boundaries may become unclear and asks how occupational therapy can embrace advocacy without losing sight of its scientific foundation and primary responsibility to client-centered, occupation-based care.

To better understand the language surrounding equity, Michelle examines current literature defining historically underserved populations and discusses why operational definitions matter. The episode explores how clear definitions influence research priorities, funding decisions, healthcare policy, and clinical practice. Without shared terminology, occupational therapy risks creating ethical expectations that are difficult to interpret, measure, or consistently implement across educational programs and practice settings.

Rather than ending with criticism, the episode focuses on practical solutions for the profession. Michelle encourages occupational therapists to reclaim advocacy as a core clinical skill through documentation, care coordination, reimbursement advocacy, durable medical equipment justification, and removing barriers to participation within their own scope of practice. She also discusses the importance of improving representation in occupational therapy research, providing practitioners with meaningful educational resources, and ensuring that advocacy remains firmly connected to occupational performance and participation rather than political ideology.

Ultimately, this episode asks listeners to think critically about how professional ethics evolve alongside society while remaining grounded in the enduring principles of occupational therapy. The goal is not to reject change, but to ensure that new ethical expectations strengthen clinical reasoning, preserve professional objectivity, and continue advancing occupational therapy as both a science and a profession dedicated to enabling meaningful participation in everyday life.

Key Occupational Therapy Concepts: Occupational Therapy Code of Ethics • Equality • Equity • Advocacy • Occupational justice • Occupational participation • Client-centered practice • Clinical reasoning • Professional ethics • Occupational Therapy Practice Framework (OTPF) • Occupational performance • Healthcare disparities • Historically underserved populations • Cultural responsiveness • Professional advocacy • Evidence-informed practice • Healthcare policy • Occupational science • Professional identity • Participation.