Occupational Therapy at the Crossroads of Genomics and Bioethics: A Review of Conceptual Pathways and Future Directions

The rapid development of genomic science beyond its molecular roots to impact many aspects of clinical and rehabilitative practice presents an epistemic challenge and a pressing ethical obligation in its use in occupational therapy. By reviewing interdisciplinary literature at the intersections of genomics, bioethics, and occupational therapy, this review article seeks to unpack the ways genomic knowledge influences the understandings of health, participation, and justice within the profession. Using critical bioethical theory and socio-technical frameworks, the review discusses the movement from reductionist genetic frameworks to relational and systems-based approaches to health that consider epigenetic, environmental, and social determinants. Key themes that emerged include the promise of new understandings of personalized rehabilitation, the potential to exacerbate existing inequities, and effects on professional autonomy and ethical responsibility. The article does not advocate for or against the inclusion of genomic science in occupational therapy, but instead, advocates for reflexive, justice-oriented ethics of genomics, and concludes with a discussion of a translational bioethical framework to help support its responsible use in occupational therapy practice and policy.