Ethical Conflicts and Knowledge of the Code of Ethics Among Occupational Therapists in Spain

Objective: This study characterized Spanish occupational therapists' knowledge of the national Code of Ethics and perceptions of professional ethics and examined associations with sociodemographic and educational variables. It quantified knowledge of key Code elements (approving body and professional values), described ethics education and participation in formal ethical support structures, and identified resources used to manage ethical conflicts in routine practice. Methods: A descriptive cross-sectional online survey was administered between March and September 2022. The analytical sample included 596 occupational therapists practicing in Spain. The questionnaire assessed participant characteristics, ethics education, knowledge and perceived importance of the Code, participation in ethics committees or similar structures, experience of ethical conflicts, and conflict-management strategies. Descriptive and bivariate analyses were conducted (p < 0.05). Results: Respondents were mostly women (86.6%) and aged 20-40 years. Although 65.3% reported university ethics education and 73.2% rated the Code as important/very important, 11.4% were unaware of its existence. Only 28.2% identified the approving body, and 16.3% correctly identified the professional values included in the Code. Ethical conflicts were reported by 43.1%. When conflicts occurred, respondents most often consulted the interdisciplinary team (25.5%) or occupational therapy colleagues (24.3%), whereas few consulted the Code (4.5%) or an ethics committee (2.7%). Ethics education and greater professional experience were associated with higher Code knowledge. Conclusions: Occupational therapists in Spain endorse professional ethics, yet actionable knowledge and use of the Code and engagement with formal support structures remain limited. Strengthening practice-oriented ethics education and accessible deliberation mechanisms may improve ethical decision-making.