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Ethics. Everyone knows ethical principles need to exist and they are important, but the continuing education unit topic is often one of the most dreaded requirements of many professional licenses and certifications. Ethics often seem relevant for big and terrible actions and not activities that most of us would deal with daily. This CEU article, however, is going to deal with this topic in a different way. We are going to talk about “everyday ethics” and the ways that the ethical principles and core values of a variety of our professional licenses and certifications could impact what we are trying to do every day with clients, business colleagues and others. We will go over specific ethical principles as well as case examples and some of the ways that we can think about potential ethical issues that we might come across and ways to manage them both professionally and personally.

The preparation of this article involved looking through a variety of ethical principles and practice standards, including occupational therapy, physical therapy, Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), iNRRTS, and others. Many of them, as you might imagine, have a lot of similarities even though they might say things slightly differently. The table below (Table 1) notes ethical principles from the American Occupational Therapy Association (AOTA), American Physical Therapy Association (APTA), RESNA, and iNRRTS and matches similar concepts across the organizations. It is interesting how the similarities line up, but when you consider societal pressures to be moral and ethical individuals, it makes sense that there would be similarities among the organizations who are trying to protect the public.

Table 1: Ethical principal similarities

AOTA Ethics	APTA Ethics	RESNA Ethics	iNRRTS Ethics
Beneficence — Taking action to benefit others, prevent harm, protecting	Accountable for making sound professional judgments.	Hold paramount the welfare of persons served professionally.	Do everything necessary to provide high-quality equipment, ongoing support and long-term service. Strive to recognize when the physiological, functional or technical needs of the consumer are beyond the capabilities of the iNRRTS Registrant (RRTS) and inform the consumer of the need for additional assessment and/or intervention. The iNRRTS Registrant, (RRTS), will assist the consumer in identifying medical professional(s) or other rehabilitation technology supplier(s) who can meet the consumer’s needs.
Nonmaleficence — Avoid actions that do harm, injury or wrongdoing	Shall enhance their expertise through lifelong acquisition and refinement of knowledge, skills, abilities and professional behaviors.	Practice only in their area(s) of competence.	Accept the responsibility to expand and improve professional knowledge and skills so the consumer receives the most appropriate technology and service available.
Autonomy — Self-determination, privacy, consent	Trustworthy and compassionate in addressing the rights and needs of patients and clients.	Maintain the confidentiality of privileged or confidential information.	Respect the confidentiality of information pertaining to individual consumers and disclose such information only with proper authorization or as required by law. Explain fully the consumer’s rights and responsibilities, including the right to work with a supplier of his/her choice.
Veracity — Accurate and objective info about role; truthfulness	Shall participate in efforts to meet the health needs of people locally, nationally or globally.	Disclose all conflicts of interest.	Present the consumer with complete information on the choices of available equipment, pricing, funding options and the consumer’s financial responsibility.
Justice — Equity, inclusion, objectivity	Shall fulfill their legal and professional obligations.   Shall promote organizational behaviors and business practices that benefit patients, clients and society.	Know and comply with the laws, regulations and policies that guide professional practice.	Serve all consumers equally regardless of race, creed, gender, sexual orientation or reason of disability. Abide by all applicable federal and local laws. Notify the consumer of the iNRRTS complaint resolution procedure.
Fidelity — Respect, fairness, integrity, discretion	Respect the inherent dignity and rights of all individuals.   Demonstrate integrity in their relationships with patients and clients, families, colleagues, students, research participants, other health care providers, employers, payers and the public.	Act in a manner that positively reflects upon the assistive technology profession.	Provide competent, timely, high-quality equipment and services to meet the physiological and functional needs, as well as the goals of the consumer.

(AOTA, 2020; APTA, 2025; RESNA, 2023; iNRRTS, 2026)

AOTA and APTA go a step further by having a number of core values and standards of practice/conduct. RESNA also has standards of practice, required duties and certain responsibilities (see Table 2 and Table 3).

Table 2: Core Values

OT Core Values	PT Core Values	RESNA Standards of Practice
Altruism: Caring for others in an unselfish way; committed, caring, responsive, dedicated and understanding	Accountability   Duty, altruism   Excellence	Keep paramount the welfare of those served professionally. Provide assistive technology recommendations that maximize outcomes and minimize a consumer’s exposure to unreasonable risk.
Equality: Treating all clients the same, regardless of differences in an unbiased way   Dignity: Respecting each person’s inherent worth and uniqueness	Compassion and caring   Social responsibility	Respect consumers’ rights and not discriminate in the provision of services or supplies on the basis of impairment, diagnosis, disability, race, national origin, religion, creed, gender, age, sexual orientation, primary language spoken, financial situation or any other protected status.
Freedom: The individual’s right to make their own decisions about their care; autonomy, independence, self-direction and initiative	Collaboration, inclusion	Inform consumers of their rights and responsibilities and promote their full participation in each phase of service. Inform the consumer about device options and funding mechanisms, regardless of financial status or funding available, and provide consumer choice in the development of recommendations.
Justice: Respecting the moral and legal rights of patients, providing them with the services that they need, and full inclusion	Accountability	Disclose to all stakeholders the role they serve in the provision of assistive technology services and devices, any financial interests or professional affiliations that may be perceived to bias recommendations and recuse themself if the conflict is likely to impair judgement.
Truth: Honest, faithful to facts and to reality and truthful	Integrity	Not engage in fraud, dishonesty, misrepresentation, criminal activity or any forms of conduct that adversely reflects on the field of assistive technology or the ability to serve consumers professionally. Not misrepresenting their credentials, titles, role or responsibilities in the field of assistive technology.
Prudence: Using reason and logic to approach decisions and self-discipline	Integrity   Collaboration	Maintain professional boundaries in relationships with consumers, their families, and caregivers discouraging any behavior that exploits the consumer’s trust.

(AOTA, 2020; APTA, 2025; RESNA, 2023)

Table 3

OT Standards of Conduct	RESNA Standards	PT Standards of Practice
Professional integrity, responsibility and accountability	Abide by all laws, regulations and policies that govern the provision of assistive technology products and services and provide consumers with the applicable information to make informed decisions. Consider the consumer’s current, future and potential emerging assistive technology needs when making recommendations.	Ethical/legal considerations, Advocacy
Therapeutic relationships	Refer consumers to other professionals, including assistive technology professionals, or provide resources when necessary to meet the consumers’ identified needs.	Community responsibility
Documentation, reimbursement and financial matters	Perform or participate in the steps of the assistive technology process, which may include assessment, evaluation, trial, simulation, recommendations, procurement, delivery, fitting, training, adjustments, repairs and/or modifications.	Administration of PT services
Service Delivery	Verify a consumer’s needs by using direct assessment procedures. Perform or participate in the steps of the assistive technology process, which may include assessment, evaluation, trial, simulation, recommendations, procurement, delivery, fitting, training, adjustments, repairs and/or modifications.	Patient and client management
Professional competence, education, supervision and training	Engage in only those services within the scope of their competence, level of education, experience and training; recognize the limitations imposed by the extent of their personal skills in any professional area, as listed in the Directory of Certified Professionals.	Education, Research
Communication Professional civility	Work in a collaborative manner with all stakeholders.	Community responsibility

(AOTA, 2020; APTA, 2025; RESNA, 2023)

Let us drill down into a few of these concepts with situations many of us face daily, starting with professional integrity, responsibility and accountability, all of which focus on maintaining public trust. Our industry has taken hits over the years with some high-profile fraudulent behavior, which is touted on the news networks as the way the industry acts. This of course, could not be farther from the truth, but each time a client or caregiver feels like they are being taken advantage of, that they are not getting what they need or deserve, or that they got the wrong product for their needs, the suspicion grows.

This concept is about having respect for all, paying attention to our roles and competence and the responsibilities we have to the public, our clients and the industry. Some of us fear looking less than competent, or we want the business of a complex client so we may try to perform a task beyond our abilities. Not only is this not the best outcome and could harm the client but also it means the next time it is even easier to go beyond our abilities. Anyone ever been doing things a certain way for a long time because you “figured it out” yourself but find out years later that you were wrong? This accountability concept also goes along with not speaking up when we know something is not OK, such as when a therapist is convinced that they are correct, and the supplier decides not to rock the boat. The last part of this principle is to maintain those professional boundaries in relationships; we all have those clients we are closest to and would go out on a Saturday if they were stuck and in need. Just be careful: taking the gift of a water bottle is one thing, but concert tickets, a bottle of alcohol or a free meal is another thing entirely. Also, guard against any preferential treatment, social media posts and getting too involved in their lives. The client’s welfare is paramount, and our relationships should be friendly and fun but professional.

The therapeutic relationships standard is all about respect, shared decision-making and collaboration. This is when we understand our clients may not choose wisely in our estimation, but they are allowed to make that choice. For me, it is especially those folks who insist on a scooter when they cannot stand up for pressure relief. It is also our respect for clients who know their needs and issues better than we ever could; they are the most important members of the team. It avoids “sour grapes” when a client prefers another supplier or Assistive Technology Professional over us and means we facilitate the transition to the other supplier/therapist with grace. It addresses conflicts immediately and directly instead of talking about the situation with other parties. This ability to communicate effectively leads to a stronger and more cohesive team and only increases satisfaction when an excellent outcome occurs. One example is a client who insists on a Group 2 basic power wheelchair with a captain’s seat for their new chair despite progression of multiple sclerosis. The OT talks her into a Group 3 complex power wheelchairs with power features as it will medically assist and is the “right” chair for her. A week after the delivery/fitting, the client goes back to her old chair as the new one is an inch higher and she can no longer transfer herself on/off the toilet and bed. As she lives alone and cannot afford caregivers, a very small change had a very large impact. A discussion to consider transfers or a closer look at the client’s issues may have caught this concern. A solid relationship with the client’s team means collaboration with all stakeholders, including those who might be more difficult to work with. Refer to other professionals or offer resources (when a need is identified by the client), such as a state assistive technology office when applicable, for help with tasks such as home automation and integration with the power wheelchair.

The documentation, reimbursement and financial matters standard is a nod to the justice principle as well as the paperwork process. It is about having the correct documentation at the right time without delays, which would impact or harm clients. A letter of medical necessity that is not written with the information required and the equipment is thereby denied is an unnecessary delay and potentially medically impactful. Occasionally, therapists will just never finish the letter after completing the evaluation, forcing the client to start over months later. Finding resources to assist and educate ourselves is key. This also includes the illegal issue of Complex Rehab Technology Suppliers “helping” therapists by completely writing the evaluations or letters for them. It is charging fairly for services delivered and working with clients to understand the payment and reimbursement process. It informs the client about all options for devices, features and funding, regardless of financial status or funding and offering choices when available. This means letting the client decide about fighting their insurance for a typically noncovered item or to decide about seeking an alternative funding source. Another part of this standard is “no arbitrary directives that compromise rights or well-being of others,” which would involve not assisting certain kinds of clients or situations where one client is charged differently than another. Any roles, affiliations or financial interest in AT services and devices should be disclosed to the team, and we should pull out of the decision-making process if those conflicts would impair our judgement.

The service delivery standard notes that working with clients should be client-centered and consistent with all the ethical and other values we hold via our licenses and certifications. The evaluation must be appropriate to the specific needs of the client, such as a second (or third) visit to trial demos, or a request for consultation with a manufacturer’s representative as an expert with a complicated system. Just because it is hard to do or a hassle is not enough to not put client needs at the forefront. The practitioner should provide services that are current, based on evidence when possible and fall within the person’s scope and skills. It includes making sure we are aware of the best products on the market to meet specific needs and that we stop using products that are not appropriate but familiar. Some examples might be using the backrest that comes as a standard item on the chair instead of an aftermarket back that is more appropriate or recommending the same type of familiar stroller when the client could benefit from the features of a different brand. It also might be using the same brand/make/model of power wheelchair for all clients instead of considering the specific benefits and features of each brand for each client. It is up to us to educate ourselves and our clients as to the best options to meet their needs. We must perform evaluations and trials when appropriate, such as a home trial when a client has poor vision or a second visit to trial various demo backrests. We can respect their right to refuse a device entirely, refuse the one we think is best and ultimately refuse to work with us any longer. This goes both ways as the ATP/therapist can also refuse to write an evaluation/letter of medical necessity that notes justification for a mobility option with which they ethically do not agree. An important part of this is also making sure the final product chosen is as appropriate as possible for the current, future and emerging AT needs, and the client/caregiver has the information required to make good decisions. Putting a client in a Group 2 basic power wheelchair with a captain’s seat when they have fast-progressing cancer with pain/weakness and will very soon be entirely unable to stand/walk could lead to long-term health implications such as pressure injuries and blood clots. We must decrease the risk of harm and maximize short- and long-term outcomes. One of our biggest jobs is to not just passively act in an ethical manner but also take steps to make positive change. One way is to fight any discriminatory policies or those that limit access to consumers. Most of us in the CRT world have fought for client rights with Medicaid, funding agencies or insurance policies, which limit access to medically necessary items. One such fight currently occurring in the U.S. is the denial of recline and expanded electronics for many CRT systems, deemed not medically necessary when they are extremely important if not vital. If you have a client willing to take the time to fight the system versus downgrade to a lesser chair, please continue to write the addendums. Pursue further action such as requesting a peer-to-peer review from the funding agency when available and help the client self-advocate for these items.

The concepts of professional competence, education, supervision and training do not mean we are CRT experts in every area but that we work within the scope of our competence, experience, training and personal skills. If I am not sure what seating solutions will best suit a young man with scoliosis, legs windswept to the side, neck lateral rotation and spasticity, then I need to seek help. After 23 years of seating, I still learn and ask every day; I had a case last week where at the initial evaluation, the supplier and I were unsure which product would meet the needs of the client. We agreed to a second visit with the client to request assistance from manufacturer’s reps from two companies offering potential solutions. Some of the most difficult parts of the CRT evaluation process can be the ability to self-assess skills and knowledge when there is a need. Most of us feel like we can figure it out on the fly and even though this may lead to a reasonable outcome, let us always shoot for a great outcome. Take specific action to maintain and grow knowledge and competence as well as to resolve incompetent practices. As we are all aware, having the ATP after our name does not automatically mean the ability to provide CRT effectively. Newly credentialed ATP suppliers and clinicians must have the appropriate guidance and supervision required to have excellent results, and this requires determination and potentially extra time and money to make this happen. The extra effort is worth it, as happy, comfortable and functional clients will keep coming back and giving grace when there are challenges with service and other business factors. Any resources being used or shared must be credited and follow copyright standards, including items such as an image off the internet for a brochure or an excellent tip your clients would love. Standing up for incompetent, illegal or unethical practices may put one’s job at risk but save a client’s life and health. Resources such as AOTA, APTA, RESNA, iNRRTS, National Coalition for Assistive & Rehab Technology and others can offer guidance and support if action is required.

The standard of communication involves offering full confidentiality, privacy, discretion and respect to client information and “story.” An interesting client may be a fascinating or funny story at a party but is unique enough to be identifiable. This includes verbally as well as social media. Some of us use social media for connecting with current and potential customers and must continually make sure of client/caregiver’s permissions as well as the understanding that once posted, the information can often be passed on and could be used worldwide. Our marketing must be truthful and accurate; for instance, say, “We will help work to maximize insurance coverage,” instead of “Medicare covers these power wheelchairs!” The “under promise and over deliver” concept in combination with truthfulness and respect moves beyond focus on a single sale to a lifelong relationship with a satisfied client. Resist the temptation to talk only to the caregiver when the nonverbal client is present; assume they can understand and would like to be included, even if the caregiver answers the questions. Try to use the preferred communication method of the client/caregiver; it is OK to say, “I can’t understand you, could you please repeat that,” for clients who speak very softly or are difficult to understand. Some clients will only use their communication device if the communication partner cannot understand their speech. Collaboration and communication with the entire team is imperative. A seating team in a clinic helping a school-aged client get a new complex power wheelchair should include (even peripherally) the school practitioner who will know the specific school issues. An adult wheelchair user who, on various days is at a group home, parent’s home and adult day care should have communication with a team member who can consider all locations. Allow clients and caregivers to take the time to ask questions, even simple ones, and avoid dominating the conversation. When conversations such as “My insurance says they will cover this folding wheelchair, and that is what I want,” occur and the response is a scoffed, “I’m sorry, but they say that, but these things are not a covered item, plus you have Parkinson’s so that is a really bad idea,” it tends to make the client feel silly/embarrassed and shut down. Being impatient and dismissive with questions may seem like it may not be large enough to be an ethical concern, but respectful communication also involves autonomy, beneficence, altruism and prudence. It may not be worthy of an ethical discussion/query or anything besides a bad review, but it also may be a pattern of negative behavior that can lead to a larger ethical issue over time.

Professional civility ties in with respectful and clear communication but is also about all professional and equitable treatment. It involves careful and active listening as much or more than talking and getting your own point across. Being nice is easy when everyone is getting along, but treating others with courtesy and civility when there is strong disagreement or opposing viewpoints can be much harder. Really listen to what clients and caregivers are saying, sometimes anger about a folding power wheelchair not being appropriate for their needs is more about grief related to their disease process and developing challenges with mobility and function than about just being angry. Clients who dig in about wanting a power wheelchair they can take apart for transport despite needing a Group 3 more complexchair may have real fears and issues about continuing to live alone if they cannot get to the grocery store. They may also live in a rural community without consistent wheelchair transport. Respectful and inclusive language is part of this as well, as we avoid describing the new client with a spinal cord injury as a “para” or the client for a stander as “the CP kid.” Using language/behavior that offers respect and refers to a client with their preferred pronouns (even if in transition), avoids the assumption  that a female companion accompanying a male client must be a caregiver (but is really his wife) and leads us to assume competence of a client who may appear severely/profoundly impaired by not talking around but to him.

An ethical issue worthy of discussion is a case example which recently occurred in a seating clinic. A young man with spastic quadriplegic cerebral palsy is attending the outpatient seating clinic with his mother and older sister for a new wheelchair. He is 21 and no longer attending school as of a few months ago. He uses an older complex power wheelchair with tilt, recline and elevation to maneuver around the home and community with supervision from family and uses only public transportation. He is able to follow directions but requires supervision and assistance for most daily tasks. Now that it is time for a new chair, his family came into the appointment asking for a manual wheelchair or stroller instead of a new power wheelchair. The family noted the chair was bulky; they could not transport it; and the client banged up the walls of the home as he tried to maneuver. The therapist noted no difficulty with maneuvering from the lobby to the seating clinic. The mother is legal guardian for this young man. The therapist led a discussion with the group about what they were interested in for a new device and shared his dismay when the dependent mobility device was brought up as the desired choice. The therapist included the client in the discussion, and he agreed that he was ok with the new option. Unsure about the dynamics, the therapist strongly encouraged independence and autonomy for the client, but the mother was insistent. The therapist advocated for independent mobility and the desire of the client to have control over his movement and expressed his discomfort with taking this away from the client. As the guardian, the mother is allowed to make the choice she perceives is best for the family and client, and the client agreed.

Another ethical scenario takes place at an ALS clinic where a supplier attends the clinic to assist with all equipment needs for clients. She attends each week and is there all day to assist. A gregarious and friendly individual, she makes connections with clients and caregivers as she notes items to be repaired, changed, and ordered. She does end up processing all new items such as alternative drive controls and support items through her company, even if the company the chair came from was a different supplier. She also sees all clients with ALS requiring new evaluations for complex chairs with the clinic therapist. Together, this CRT Supplier and therapist recommend a certain brand of chair with a certain cushion and controls for all new clients for their first chairs. They feel that they do a good job and clients are pleased with the outcomes. The supplierand members of their company often take the therapist to lunch and give her Christmas and birthday gift cards to a coffee shop. This case includes ethical concerns about integrity, truthfulness, beneficence and justice via effective service delivery. Clients deserve the right to have unbiased information to make an informed choice without undue influences related to the close relationship of the clinic with the supplier.

Another example to consider are the ethics of inaction. We must take action to resolve incompetent, unethical and impaired practices and report potential or known unethical or illegal actions. Avoiding thoughts such as: “Not my business,” “I don’t want to get involved,” “I am sure they are OK,” “It’s not really a big deal,” “It doesn’t really matter,” “I’m just one person,” “Someone else will do it,” is paramount to hold the welfare of the clients we serve professionally in the forefront. Taking ethical action can be uncomfortable or make life more challenging, but it is the right thing to do. Some other not so obvious everyday situations might include:

• Providing an evaluation/chair/device that you are not adequately trained to support or manage.
• Deciding on a device too quickly when the client needs a second visit or demo trial to really know what would be best.
• Billing for not-completed work such as labor or items that did not work on the chair.
• Blurring the lines of personal and professional relationships.
• Refusing to move off formulary lists or refer to another supplier to meet client needs.
• Not fully considering long-term needs with progressive disorder.

One way to manage ethical issues that may present is to consider the process of how you may need to act when an issue arises. The bulleted list below are common strategies for managing ethical issues in an organized manner (Tech Leaders, 2025).  

• Understanding the ethical issue/gathering the relevant facts — Make sure you have all the information you require about the situation, stakeholders and actions.
• Apply ethical principles and consider issues — Find additional information and resources. Consider what the issues are that are being violated and by whom.
• Assess and determine alternatives for action —What might you possibly do about the issue? What are the potential short- and long-term impacts?
• Choosing the best course of action —Take action after considering all options. Communicate with stakeholders.
• Implement and evaluate the results of an action or outcome —Did the action you took resolve or manage the issue? Monitor, document, and apply information for future situations.

A few other situations to consider how you might take action could include the following cases. Think through each scenario with the five-step process noted above.

1. A resident physician refers a client for a scooter when they asked for it in a recent appointment. The doctor’s notes indicate the client has multiple sclerosis, leg weakness with difficulty standing/walking, spasticity and lower body numbness. The client wants a scooter but has not done any research on available options. You do not have a qualified CRT Supplier on your company staff but could use the sale.
2. A therapist recently left the school where she assessed complex wheelchairs without finishing the documentation for some of the children on her caseload. Your supervisor and the families want these letters of medical necessity completed so the paperwork and equipment can be funded and dispensed and ask you to finish them, even though you have not met/treated the kids in question. You, as a therapist, are not experienced with CRT like the original therapist, but as long as the CRT Supplier helps, it should be fine.
3. A client with a complex power wheelchair has been “a total pain” and called you out many times to the home. She calls you again to apologize for being difficult and gives you two tickets to an event that you are dying to go to as “payment” for all your trouble.
4. Your company has been having terrible trouble getting certain electronics and power features covered by the funding source for complex power wheelchairs. So, to save time and trouble, your team has decided to offer new clients with a basic power wheelchair with tilt and elevate instead of a complex power wheelchair with additional recline and elevating foot platform as well as expandable electronics. This will save disappointment and allow you to have a much faster eval to delivery timeframe.

Navigating the everyday ethics of working with clients with mobility needs can be daunting at times and there are pressures from employers, state/provincial and federal laws, client and caregiver needs and others. Hopefully, the information and examples provide options to consider and keep at the forefront. If you encounter ethical issues in your practice, information about who to turn and resources for ethical issues might include:

• State/provincial, district, territorial or national authority responsible for regulating the occupational therapy and physical therapy professions.
• RESNA, iNRRTS, NCART
• U.S. Department of Health and Human Services, Office of Inspector General (800) 447-8477, TTY: (800) 377-4950 or http://oig.hhs.gov/fraud/report-fraud/index.asp
• Centers for Medicare and Medicaid Services (800) 633-4227, TTY: (877) 486-2048
• Individual insurance carriers, other third-party payers or health plan sponsors.
  • Note: Most entities have reimbursement policies and procedures that outline coding methodology, industry-standard reimbursement logic and regulatory requirements. Inquire directly to the specific company when reimbursement information or clarification is required. Most policies and procedures can be found on the payer’s website.
• State agencies regulating the insurance industry.
  • Office of the Insurance Commissioner (Commissioner of Insurance) or (state) Department of Insurance www.naic.org/state_web_map.htm

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References

Occupational Therapy Code of Ethics. (2020). American Journal of Occupational Therapy. 74(3), 7413410005p1–7413410005p13. doi: https://doi.org/10.5014/ajot.2020.74S3006

Code of Ethics for the Physical Therapist. (2025). American Physical Therapy Association. Retrieved from codeofethicshods06-20-28-25.pdf

Code of Ethics. (2026). International Registry of Rehabilitation Technology Suppliers. Retrieved from Code of Ethics – iNRRTS

Updated Code of Ethics and Standards of Practice. (2023). Rehabilitation Engineering Society of North America. Retrieved from Code of Ethics and Standards of Practice

Larsen, T. (2026). 5-Step ethical crisis decision making for tech leaders. Retrieved from 5-Step Ethical Crisis Decision-Making Guide for Tech Leaders [2026] | Technical Leaders

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Amber may be reached at amber.ward@advocatehealth.org.

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