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

Abstract

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.

1. Introduction

The rise of genomics has signified not only an achievement in technology for the life sciences, but also a deep ontological and epistemological shift in how we think about health, identity, and the human condition itself [1]. Genomics began as a complete study of gene structure, function, and interactions in the genome and has developed into a highly advanced and sophisticated scientific enterprise. Today, it encompasses a constellation of diagnostic, predictive, and interventional modalities, ranging from high-resolution genotyping and whole-genome sequencing to somatic gene editing and preimplantation genetic diagnosis (PGD). The application of these technologies, although embedded in the practices of laboratories and clinics, implicitly connects to philosophical questions about the limits to human intervention, what the term normalcy means, and the obligations we owe to those living now and in the future [2,3,4,5].

This development is situated within a historical context that begins with the description of DNA as a double helix in 1953, through the collaborative efforts of Watson, Crick, Franklin, and Wilkins [6,7]. The establishment of the genetic code, and then the later ad-vent of molecular genetics, constituted a revolution in not only biology but the metaphors we use to understand life itself—for example, genes as “blueprints,” “scripts,” or “codes of destiny.” The proliferation of recombinant DNA in the 1970s, the sequencing of the human genome in the 1990s, and most recently the application of CRISPR-Cas9 gene editing, have collectively ushered in a new age of biological agency [8,9,10]. In this sense, the human body is no longer a passive site of medical intervention, but an active site of techno modification and epistemic reconfiguration.

In light of these scientific developments becoming better established, questions not only arise regarding if they are technically possible or safe, but it raises the question of if they are ethically and/or socially acceptable. Alteration of genetic material—alterations in individual bodies or altered in a way that will affect future generations—raises ethical questions that call into question consent, resources, and what it means to produce changed traits that are part of our humanity, normal, difference, and ability. For example, to what degree is it possible to have informed consent when something has the probability of having permanent effects on offspring? Will only a privileged population have access to these treatments and will this only deepen and entrench existent inequality? What about larger philosophical questions regarding normalcy, ability, difference, and our understanding of manipulating particular traits as part of the human experience of existence [11]?

To address these concerns, a constellation of international ethical frameworks and legal instruments have emerged. The Declaration of Helsinki (1964) prioritizes the protection of individuals involved in biomedical research, with a key focus on voluntary participation, transparency of protocol and risk, and proportionality of risks to benefits [12]. The Oviedo Convention (1997), in turn, codifies more stringent prohibitions, particularly with regard to germline modification, reflecting a commitment to intergenerational justice and the inalienability of human dignity [13,14]. European Union directives on biotechnology consistently affirm the centrality of ethical evaluation and democratic deliberation in shaping research and innovation trajectories [15,16,17]. Altogether, these documents uncover a nascent normative consensus, albeit with national variations, that biomedical innovation should not be dissociated from moral responsibility, legal accountability, and social inclusion. This wider bioethical space provides the necessary frame for exploring what genomics might mean in particular areas of care, such as occupational therapy, which is now facing its own professional and philosophical challenges to adapt to this rapidly changing context.

Recognizing this shifting ethical and regulatory context, the professional domain of occupational therapy is at a pivotal moment in its evolution. Historically situated within the ethical principles of holistic, person-centered care, occupational therapy takes into ac-count interrelated physical, psychological, and socio-environmental aspects of human functioning [18,19]. Therefore, it is not only situated in a unique position but it is also morally obligated to critically examine and reflect on the impact of genomic knowledge on traditional understandings of ability, impairment, participation, and identity. That is, when genomic knowledge becomes part of rehabilitation practice, it requires people not only to change clinical procedures and protocols, but also to fundamentally shift ontological assumptions that underpin therapy engagement: What does it mean to rehabilitate a body whose “deficits” are increasingly defined at the molecular level? How can therapists engage with the implications of probabilistic risk, predictive diagnostics, or pre-symptomatic care? And, as genomics becomes further enmeshed with broader biopolitical forces that shape policy on matters of reproduction, aging, enhancement, and disease prevention, the profile of the occupational therapist becomes more than a technical role, but also a role of ethical vigilance, reflexivity, and a necessary participant in discussions around what constitutes a meaningful, dignified, and inclusive life.

Accordingly, this article seeks to document the trajectory of genomics as it interfaces with occupational therapy, and to analyze the bioethical, sociopolitical, and theoretical implications of that intersection. Drawing on literature from critical bioethics, science and technology studies, and human-centered rehabilitation sciences, it argues for a reconceptualization of professional responsibility in the genomic era. The objective of this review is to explore how emerging genomic paradigms reshape foundational assumptions in occupational therapy, and to critically examine the ethical frameworks necessary to guide their integration into person-centered rehabilitative practice.

2. Theoretical Framework: Foundations in Bioethics, Genomics and Core Technologies in Genome Editing

The conceptual emergence of bioethics in the early 1970s marked a pivotal reorientation in the moral imagination of biomedical science. Coined by oncologist and ethicist Van Rensselaer Potter in 1971, the term bioethics was envisioned not merely as an adjunct to medical ethics, but as a comprehensive ethical response to the existential challenges posed by rapid technological advancements in biology and medicine [20,21]. Combining the Greek bios (life) and ethos (custom or moral character), bioethics sought to foster a new epistemology of moral reasoning, attuned to the complexities of biological intervention within ecological, social, and human systems [22,23,24].

Although Potter’s ecological vision of bioethics emphasized the interdependence of human health and planetary survival, the discipline also took root through more institutionalized channels [25]. In the United States, the emergence of unethical human experimentation after World War II ultimately led to the establishment of the National Research Act of 1974 (Pub. L. 93–348), which was signed by President Richard Nixon and created the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research [26,27]. The Commission later published the Belmont Report (1979), and identified the principles of respect for persons, beneficence, and justice that provided the framework for research ethics and oversight across the United States and around the globe [28,29].

Bioethics, within the framework of ethics, draws from a multitude of philosophical traditions, including, but not limited to, deontological ethics, utilitarianism, communitarianism, and virtue ethics. The moral vocabulary of bioethics is dynamic and specific rather than immutable and universal, having been informed by ongoing conversations and debates about the nature of the human subject, the reach of moral responsibility, and whether emerging biotechnologies are ethically permissible.

Among the persistent core principles are the following: Autonomy, not just the ability to make choices, but the capacity for rational self-determination, which is premised on Kantian moral philosophy [30,31]. Autonomy embodies respect for persons as ends-in-themselves, which is also reflected in each person having inviolable dignity, and therefore they must not be used as means to an end for health, science, or society. When considering the bioethical concept of autonomy in relation to genomics, difficult challenges arise, either when actions affect incapable individuals such as embryos or future generations, or when probabilistic knowledge diminishes meaningful decisions [32,33].

Beneficence and non-maleficence, outlining a duty to act for the benefit of individuals and communities while avoiding harm, are principles that demand responsible action [34,35]. Although these principles are derived from the Hippocratic tradition, they have recently been re-contextualized in bioethics. These principles are especially relevant when the risk–benefit calculation of genomic interventions is still either uncertain or speculative. The risk of unintended consequences, such as off-target mutations or psychological dis-tress, calls for cautious, evidence-based approaches to innovation [36,37].

Justice, a multifaceted and often contested principle, involves both distributive equity and procedural fairness [38,39]. In genomics, justice requires in-depth analysis of access disparities, such as those based on socioeconomic status, geographic location, or genetic ancestry. The risk of reinforcing structural inequities through unequal access to genetic therapies or participation in research trials poses an ethical challenge that transcends individualistic models of care [40,41].

Other principles, such as veracity (truthfulness), solidarity, accountability, and respect for dignity, are gaining attention as bioethics is broadening its focus from clinical practice into the sociopolitical and cultural realms. Solidarity specifically draws attention to the intersubjective aspect of moral life and speaks to the collective responsibility for imagining genomic futures that are inclusive, participatory, and cognizant of upstream power dynamics related to marginalization [42,43].

Governance of genomic technologies at both the international and European levels has matured into a framework of policy, ethics, and governance rather than a series of dis-connected guidelines. The World Health Organization (WHO)’s 2021 report Human Genome Editing: Recommendations identified nine priority areas, from research registries to intellectual property, public engagement, and equitable access, which establish the framework of governance in relation to somatic and heritable human genome editing [44]. At the level of global coordination, multi-national initiatives like the National Academy of Sciences, Engineering, and Medicine (NASEM)’s report 2021 and the International Commission on the Clinical Use of Human Germline Genome Editing (2020) have proposed levels of translational thresholds, for instance clinically acceptable safety/efficacy thresholds, independent peer review and global coordination for governance purpose, and that responsibility links the use of genomics in clinical practice and health systems to accountability [45].

In the European setting, this worldwide horizon is in part fortified by regionally-specific instruments, notably the Oviedo Convention on Human Rights and Biomedicine (1997) and the EU Directive 98/44/EC on the Legal Protection of Biotechnological Inventions, both of which provide normative anchors for human dignity, informed consent, and noncommercialization. The Nuffield Council on Bioethics (2018) report, Genome Editing and Human Reproduction: Social and Ethical Issues, helpfully extends ethical reflection by foregrounding two values: welfare and solidarity, asserting that genome editing, however undertaken, must be carried out in ways that promote the welfare of the individual, but also defend against increasing inequity within society [46].

In fields like occupational therapy (OT), these frameworks play an important part in the policies that may inform the integration of genetic data and technologies into rehabilitative practice, ethical decision making, and policy advocacy. They invite OT practitioners to consider the following: Under what conditions is a genomic intervention in keeping with principles of participation, justice, and meaningful occupation? How do we ensure access is equitable? How do we maintain professional autonomy when genomic risk profiles, predictive diagnostics, or enhancement logics enter practice? In this way, the global and European guidelines in occupational therapy have become a bridge between emerging genomic science and the lived experience of participation, identity, and occupation in occupational therapy [5,47].

The epistemological transition from classical genetics to contemporary genomics rep-resents not merely a methodological broadening, but a fundamental reconfiguration of biological identity [48]. Traditional Mendelian paradigms, with their emphasis on discrete gene–trait associations, have presented a systems-oriented view of the genome as a complex, multilayered regulatory network [49]. In this context, the unit of inquiry shifts from the individual gene to the genome as a whole, representing a dynamic topography where 95% of the non-coding sequences are increasingly acknowledged for their roles in gene regulation, cellular differentiation, and organismal development. This insight is ontological—the gene is no longer a fixed structural entity but a functional phenomenon, and it emerges from interactions among sequences of nucleotides; epigenetic modifications; chromatin packaging; and environmental influences. The implications are profound; in this view, causality is no longer deterministic but reframed as probabilistic and relational, which challenges robust assumptions about pathology, identity, and prediction.

The term “genome” entered scientific parlance in the early 20th century, but gained cultural resonance with the molecular revolution and speculative literature such as Jack Williamson’s Dragon’s Island (1951), which prefigured many of the ethical and existential concerns of genetic intervention [50,51]. In present times, the genome refers not only to biological potential, but also serves as a metaphor for control, enhancement, and risk. From a systems biology perspective, the genome is not a passive code but an active interface within a larger biological and ecological system. Developments in the sciences of omics show that genetic data becomes meaningful only if the data is manipulated and/or expressed [52,53]. Epigenetic mechanisms, such as DNA methylation and histone modification, demonstrate that heritable change can occur independently of sequence alteration, adding temporal and environmental dimensions to genomic science [54,55]. Likewise, single-nucleotide polymorphisms (SNPs) have shifted from being viewed as minor anomalies to markers of disease susceptibility and therapeutic stratification [5,56,57].

In light of this epistemological re-framing, the development of genome editing technologies has also re-defined the capacity to act on biological matter. Older tools like zinc-finger nucleases (ZFNs) and TALENs provided targeted editing but were limited in scope, while CRISPR-Cas9 (notably first published in 2012) represents a radical methodological rupture [58]. Indeed, CRISPR-Cas9 represents a powerful RNA-guided system, one previously used in bacterial immune defense, that enabled unprecedented efficiency and specificity in gene editing, and will become even more important once theoretical interventions into human DNA are plausibly positioned within the clinic [59].

The quick uptake of CRISPR has broadened the range of intervention from somatic cells, to germline, embryonic, and pluripotent types. Somatic editing, because it is non-heritable, is generally considered ethically acceptable in carefully regulated, controlled circumstances; germline editing is ethically deeper because it brings more moral complexity and more complex potential intergenerational accountability [59,60,61]. The alarming case of He Jiankui, who edited CCR5 in human embryos for the purpose of creating HIV resistance, exemplifies the risks of premature application: insufficient regulation, unclear necessity, and unanticipated biological vulnerabilities [62,63].

Technical problems remain; off-target effects, mosaicism, and the limits of delivery vectors still exist even if they are improving. The more serious problem is not that they are difficult to deploy, but that they need to be governed. Who gets to say which traits should be targeted? Whose values determine the boundaries of “normal” or “disability?” All we have to do is keep in mind Foulcault’s notion of biopower—genomics tools do not just treat disease; they reorder populations, distribute risk, and reproduce hierarchies in the name of biology [64].

Scholars in critical bioethics and science and technology studies (STS) have cautioned against interpreting genome editing as a value-neutral scientific development. Phrases like “fixing” or “optimizing” can carry normative force and often reveal ableist, technocratic, or market assumptions of what types of life are worth living. Furthermore, this rhetorical framing can exemplify what Miranda Fricker has called “epistemic injustice,” where individuals or groups are wronged as knowers. In the context of genomics, marginalized groups may fail to have a role in specifying what constitutes a dominant narrative about health, ability, and intervention, and who among them can have their experience counted as legitimate or intelligible. Without reflexive and inclusive deliberation around genomics, the genomic future stands to reinforce structural inequalities and narrow definitions of human worth. For those working in occupational therapy and allied health fields, these bioethical underpinnings are not just external propositions, but internal imperatives. As practitioners, bioethics calls for an intentional reflection about the ethical contexts pushing and pulling therapeutic relationships, service delivery systems, and access to care. As genomics is increasingly demonstrating its value in clinical practice, deep bioethical literacy is needed to respond to regulatory compliance as well as to engage with the ethical complexities central to human-centered care [65,66]. To clarify our conceptual framework, Figure 1 depicts an interconnected structure that highlights our core bioethical principles of autonomy, beneficence, justice, and solidarity, epistemological shifts in genomics (moving between genetic determinism to relational and systems thinking), and occupational ethics (the translational space where ethical reasoning becomes practice). The arrows illustrate that each of the ethical principles guide (inform) our interpretations of genomic information (e.g., informing consent under uncertainties and equitable access), while genomic epistemology reshapes how we reason about these occupations in practice toward contextual and person-centered approaches. The overall representation in the triangular figure presents an iterative cycle where the principles inform interpretation, the interpretation informs our practice, and the practice in turn shapes our informal ethical framework around the contexts of genomics in occupational therapy.

3. Materials and Methods

This article serves as a conceptual and critical narrative review, rather than a systematic review. It applies a critical interpretive methodology that stems from ethical analysis and socio-technical systems (STS) theory. Accordingly, the review does not follow an empirical or hypothesis-driven model, but rather a critical review of the interdisciplinary literature, legal documents, ethics declarations, and policies to inquire into how genomics intersects with occupational therapy (OT) ethics, philosophy, and practice. The review aims to synthesize conceptual and normative insights as opposed to generating empirically generalizable findings.

The sources were selected purposefully and by criteria based on their established importance and conceptual relevance in bioethics, occupational science, and science and technology studies (STS). Sources were included if they referenced key bioethical principles (e.g., autonomy, beneficence, justice, and solidarity), addressed genomic or epigenetic advancements in relation to health care and rehabilitation specifically, or addressed the ethical and philosophical roots of occupational therapy. Policy documents, including the Oviedo Convention and the Universal Declaration on Bioethics and Human Rights, professional codes, including the codes of the World Federation of Occupational Therapists (WFOT) and the American Occupational Therapy Association (AOTA), and key bioethical case studies (e.g., He Jiankui’s germline editing) were selected for their paradigmatic and discursive significance. No temporal or linguistic limitations were applied; however, priority was given to peer-reviewed publications in high-impact journals published in the last 12 years.

All materials were analyzed in an interpretive fashion, treating them as normative and conceptual artifacts rather than as data. The analysis was interpretive by virtue of constructivist practices, with the understanding that biomedical discourses, institutional infrastructures, and socio-cultural imaginaries collectively co-construct ideas of normalcy, pathology, and professional responsibility in the era of the genome.

It is important to recognize the pitfalls of the approach. It is also a conceptual paper rather than a systematic paper, so it makes no claims to completeness or quantitative generalizability. Instead, its contribution is to centralize theoretical integration, post an ethical interpretation, and to offer a reflexive frame for thinking about and contextualizing the ethical elements of the incorporation of genomics in occupational therapy research, policy, and practice.

4. Results: Ethical Implications and Emerging Dilemmas

This part offers a selection of ethical dilemmas and regulatory concerns that illustrate some of the central tensions between genomics and human dignity. The analysis in part one begins with an exemplary case (He Jiankui) that assists in understanding intergenerational risk, and then provides philosophical discussions often related to enhancement terminology, and finishes with a comparative background of regulatory approaches from coast-to-coast globally. The presented scenarios are by no means exhaustive but have been selected for their conceptual complexity and relevance to the ethical responsibilities of occupational therapy. The ability to modify the human germline has come to represent one of the more ethically fraught frontiers of modern biomedical science, and raises deep questions about not only safety/efficacy but also what human autonomy means, what the moral status of future persons might be, and the normative boundaries of human identity. Unlike somatic interventions, which only affect the individual receiving the intervention, germline changes are inheritable and thus have an intergenerational dimension.

This issue became especially evident in 2018, when Chinese scientist He Jiankui re-ported he had been able to use CRISPR-Cas9 technology to edit the CCR5 gene in two embryos, which eventually resulted in successful births [67,68]. The purported aim was to endow the embryos with resistance to HIV infection. The justification for HIV-related resistance was widely considered to be ethically indefensible since preventative treatments for HIV already existed, and disabling the CCR5 receptor might actually increase susceptibility to other pathogens. As the news circulated, a consensus quickly emerged world-wide among scientists, ethicists, and governments that He had acted irresponsibly due to the absence of transparency, ethical justification, and peer oversight. Importantly, the incident illustrated a range of concerns about the technical risks associated with CRISPR-Cas9 products, specifically the risks of off-target effects and mosaicism. It also raised a more profound ontological question: Can scientific intent on its own serve as a basis of ethical permissibility, without the kind of societal engagement that leads to deliberation on whether the benefits outweigh ethical concerns?

When viewed from an occupational therapy lens, the He Jiankui incident raises is-sues of therapeutic autonomy and takes on bioethical contexts of the meaning of intervention. If genomic decisions are made without clear participatory and transparent means considered, we chip away at the autonomy of the client and practitioner, as therapeutic relationships are not subject to technoscientific authority. Casting genetic difference as pathology further entrenches the ableist assumptions that occupational therapy seeks to act against, namely, suggestions that devalue human variation and lived diversities. The OT paradigm understands health and function in relational terms, through participation and meaning rather than correcting biology. Germline editing illustrates an important tension between biomedical ambition and occupational justice—that is, who is to decide what a “life worth living” looks like and who is legitimatizing or erasing others’ possibilities? Situating bioethical tension in OT contexts prioritizes the profession’s mission statement, which aligns with agency, inclusion, and dignity in all forms of human embodiment [69].

Such events reinforce the need for an appropriate and enforceable ethical charter. Somatic gene editing has largely been regarded as ethically acceptable if restricted to use in non-reproductive cells, and is therefore non-heritable; somatic editing has been regarded as ethically acceptable (for serious, life-limiting disease) if undertaken with appropriate attention to safety, equity, and distribution [70,71]. However, the ethical landscape changes significantly when interventions are introduced into the germline. As germline edits are irreversible, these edits may create new avenues for social disparities, and we can never find an opportunity to obtain consent from future generations of patients. For these reasons, germline work requires much greater normative thought.

Central to this debate is the delineation between therapeutic intervention and human enhancement, a boundary that has grown progressively ambiguous within the context of contemporary genomic advances. While therapeutic interventions are conventionally framed as morally legitimate responses to disease or impairment, enhancement entails the modification of traits beyond a species-typical norm or health-related necessity [72,73]. Nonetheless, this distinction is neither morally obvious nor widely assumed. For example, Julian Savulescu has noted that if we agree that enhancing cognition, immunity, or emotional resilience would allow for a net-beneficial quality of life, a blanket prohibition on enhancement could be considered morally inconsistent [74]. Michael Sandel, on the other hand, says that using biology as a tool makes children into things that parents choose, which goes against the moral ideal of being humble in how we receive human life and the value of the gifted [75]. Sandel claims that the greatest moral danger of enhancement is not inequality, per se, but the hubris to accept the human condition with all of its intrinsic circumstances of being unchosen [76].

These philosophical perspectives represent different strains of anthropology: one that views the human organism as an open-ended, self-optimizing project and another that accepts ontological limits as a part of ethical life. The issue between the two is not just held in an academic sphere, it also raises significant concerns about policy, clinical practice, and public trust. If gene editing becomes the norm in reproductive health or elite educational institutions, what implications might that have for individuals or families that choose not to or could not afford genetic enhancement? In these regards, such cases may put society down a path toward two races, one curated genetically and the other just “natural” and thus disadvantaged.

From a policy point of view, the international situation is heterogeneous and often poorly regimented. Article 13 of the Oviedo Convention on Human Rights and Biomedicine prohibits any modification of the human genome that is heritable, emphasizing that biomedical innovation must respect human dignity or societal consent [77,78]. Yet not all nations are signatories, and even among those that are, enforcement mechanisms vary significantly. In the United States, a patchwork of institutional review boards and federal guidelines govern gene editing, but the lack of binding national legislation leaves space for regulatory evasion [79]. The United Kingdom has taken a more permissive approach under tightly defined circumstances, allowing mitochondrial replacement therapy and research into germline editing under the Human Fertilisation and Embryology Authority (HFEA) [80]. Meanwhile, in countries such as China and Russia, regulatory enforcement has been inconsistent, highlighting the difficulties of establishing global norms in the absence of binding international law [81].

Furthermore, the mere existence of law cannot resolve the deeper moral issues associated with genome editing. For instance, normative ambiguity lies in the constructs of “serious genetic disease,” “therapeutic necessity,” and “acceptable risk,” which are open to cultural, historical, and political interpretation. What one culture may define as a treatable condition, another may celebrate as neurodiversity or an embodied difference. The threat of implicit eugenic reasoning, which implies that differences from a genetic norm equal pathology, continues to loom, especially when disability justice and genetic counseling may intersect.

5. Discussion: Occupational Therapy at the Crossroads of Genomic Integration

With genomics started to be utilized as part of contemporary health care, an OT practice rooted in humanistic, biopsychosocial, and justice-oriented paradigms is faced with the intersection of opportunity and ethical tension. Genomics has the potential to provide new information and understanding surrounding the etiology of disability and intervention specificity; however, embedding genomics in occupational therapy practices creates a challenge to the foundational understanding of health, function, and meaning that is inherently wrapped in the very definition of occupation [5,82]. This time of convergence is a call to reconsider epistemological commitments of the profession, ethical imperatives, and its position in the navigation of the socio-technical landscape of post-genomic medicine. Occupational therapy has always celebrated itself as a profession that is deeply situated in the lived experiences of persons, such that the practice of occupational therapy prioritizes participation, self-determination, and meaningfulness in everyday life. Occupational therapy prioritizes functions over diagnosis, context over abstraction, and enables rather than corrects. Given this, the incorporation of genomics into occupational therapy practice introduces some inherent tension. Genetic information can in some instances allow therapists to better predict functional challenges, personalize interventions, and collaborate in interdisciplinary practices through a lens of personalization. In the opposite direction, misunderstanding and reliance on genomic stories can potentially reinforce reductionist and individualizing logics that contradict occupational therapy’s holistic, contextualized, and situated understanding of humanity [83,84].

It is not just taking on a new area of study, but a shift in the way occupational therapists think about human difference, capacity, and therapeutic accountability. For example, genomic data can identify neurodevelopmental pathways in infancy, predict the trajectory of degenerative diseases, or indicate risk to environmental exposures. This type of information may play a role in early intervention, prevention, or informing families, while also introducing anticipatory models of care that unfold in a logic of risk rather than actual lived experience [84,85].

This epistemological transition raises some ethical and theoretical dilemmas. The in-creasing incorporation of genomics into occupational profiles has the potential to medicalize diversity in ways that are contrary to the profession’s commitment to neurodiversity, cultural humility, and inclusive practice. The designation of traits as “genetic abnormalities” may represent normative assumptions regarding productivity, independence, or behavioral conformity, and these assumptions are contingent on culture—not necessarily universally applicable. Occupational therapists therefore need to develop a critical literacy in genomics, not simply to make scientific content clear, but also to question its assumptions and the discourse it legitimizes.

Secondly, incorporating genomic tools may direct the therapeutic conversation to-ward a model of expert-driven meaningful interpretation, potentially displacing the client-centered, narrative-based ethos that is essential to occupational therapy. If genetic predispositions or molecular diagnoses begin to dictate therapeutic pathways, the client’s own goals, values, and occupational identity risks becoming secondary to the clinical imperatives of genomic data. Sustaining relational and participatory care in the situations of technoscientific authority will not only require professional awareness, but instead the development of new dialogical competencies that enable ethical co-navigation of uncertainty, probability, and choice.

Additionally, integrating genomics challenges the profession of occupational therapy’s boundaries and scope of practice. While some may argue for appropriate expanded training and certification in genetic counseling or bioinformatics, others will be apprehensive of compromising OT’s distinctive disciplinary lens. This may not only expand occupational therapists’ scope of practice to include “learning genomics,” but also move the knowledge base of genomics into an enrichment of the profession’s established philosophical stances. Beyond the ethical implications for individual practice practitioners, the ethical implications of incorporating genomics extend to the systems and societies where OT practitioners are required to practice. As genomic medicine begins to promote value to insurance models, educational placement, reproductive choices, and even preemptively policing, occupational therapists are practicing at a critical intersection of genetics and education and must prepare to advocate for policy to address the instrumentalization of genetic knowledge and health (including occupational therapy knowledge) and its promotion of inequality and surveillance. That said, it should also be recognized that this bioethical lens is limited. Opponents could say that prioritizing ethical reflexivity and structural awareness could undermine the possible advantages of genomic precision for individualized care, especially if a genomic test could help to alleviate suffering or im-prove longer-term functional outcomes. Some academics also argue that having a cautious approach to genomics may slow the pace of innovation or make professionals hesitant to work with new methods of technology. Additionally, whilst the critical frameworks dis-cussed in this paper are valuable in probing reductionist or ableist assumptions and ide-as, they are themselves must be situated and debated as they are related to particular philosophical traditions rather than simply a blanket space for agreement. Thus, a balanced approach would remain open for engagement to other perspectives, such as those offering a more practical, pragmatic, or outcomes-based engagement of genomics into occupational therapy. Consequently, occupational therapy’s engagement with genomics should be given structure consistent with scientific innovation, humanistic ethics, reflexivity, and structural consciousness. This means both re-evaluating documents such as the WFOT’s Code of Ethics, and the AOTA’s Vision 2025, and participating in interdisciplinary discussions that are influential in how genomics is crafted and regulated. As part of this engagement, we need to attend to the call for occupational justice, which is the belief that all people have the right to participate in occupations of meaning, regardless of genetic disposition, ability status, or viewed ‘deviation’ from normative developmental trajectories.

The incorporation of genomic knowledge into occupational therapy practice requires the systematic re-evaluation of models, not mere incremental adopting of existing models. In the case of the Model of Human Occupation (MOHO), genomic or epigenetic findings may relate to the performance capacity dimension (for example, predicting someone’s cognitive or motor responsiveness behaviors) while volition and habituation continue to underpin meaning, motivation, and daily patterns [86]. At the same time, the Canadian Model of Occupational Performance and Engagement (CMOP-E) highlights the triadic interaction of person–occupation–environment (with spirituality in the center) [87]. Genomic data enhances the person aspect by extending biopsychosocial paradigms with molecular information that still must be interpreted within engagement and environment paradigms to maintain a holistic, client-centered approach [88]. This means no matter what the genetic risk profile may indicate for an “intervention plan,” the therapist uses that information in consideration of the person’s valued occupations, roles, and routines. For example, if the genomic marker suggests a slower neuroplastic recovery after a neurotrauma-associated gene, then consideration of intervention dosage or timing may change (MOHO: performance capacity) but the activity will still represent the occupations the client desires or enjoys (CMOP-E: occupation & engagement).

Recent development of rehabilitation research suggests that as rehabilitation continues to move towards “precision rehabilitation” (which incorporates the use of biomarkers, genomics, and big data), OT conceptual frameworks will need to adapt or develop new approaches to continue to remain relevant and responsive [5,89]. In this sense, the challenge for the profession is not simply to adopt new methodologies but to adapt it to existing models and substantively integrate those into the established models of care that underpin the unique occupational therapy contribution in a post-genomic world.

In new practice situations, genomic information could direct early screening and intervention efforts; for example, in the situation of children presenting with neurodevelopment disorders, adults with neurodegenerative diseases, and individuals with musculo-skeletal conditions with genetic influences. Occupational therapists might utilize genomic risk profiles to understand genomic findings in conjunction with patients’ lived experiences and environmental conditions within a more global assessment process using existing assessment approaches to determine patients’ abilities [5,90].

In interdisciplinary teams, occupational therapists may work on community genetic counseling sessions, support adaptation planning after a diagnosis has been disclosed, and work on supporting equitable access to precision rehabilitation technologies. Education in this translational turn means new competencies in ethical reasoning, interpreting genetic data, and communicating about uncertainty. In this way genomics does not displace OT’s humanistic ethos, but instead asks the practitioner to re-interpret their ethos under new scientific and ethical conditions. Strengthening these translational linkages will allow occupational therapy to continue its leadership in integrative, justice-oriented health care [84,91].

Although the ethical and conceptual considerations around genomics provide helpful theoretical context, the potential integration of these concepts into practice as occupational therapy requires concrete and actionable practice integration. Occupational therapists are increasingly engaging with genomic information in multiple areas of care, through both formal and informal engagement, which informs either assessment or intervention processes while remaining humanistic to the profession. In pediatric clinical practice, for example, genomic diagnosis often initiates complex decision-making processes that span beyond clinical explanation to family adaptation and involvement. Occupational therapists may become key intermediaries who map environmental and occupational demand, co-design family routines, and help parents navigate ambiguity sometimes encountered after the disclosure of genetic capital. In recent survey data, OTs indicate that they are beginning the formalization of such referrals, which underscores a role in collaborative, post-diagnostic socioeconomic support networks [90].

Likewise, in adult rehabilitation and management of rare diseases, genomic-driven interventions that are gene silencing or editing will lead to changing functional trajectories that require responsive, occupation-centered follow-up. In the case of hereditary transthy-retin amyloidosis (hATTR), OTs have been shown to provide longitudinal feedback related to follow-up within graded activity programs, fatigue management, and recalibrating life roles as function improves or fluctuates after treatment. These follow-up practices illustrate an example of how genomic medicine can be implemented within daily rehabilitation practice rather than being treated generically as a biomedical novel intervention [92,93,94]. The principles of precision rehabilitation are also consistent with the occupational therapy emphasis on individualized, contextualized practice. Through a combination of genomic data, digital phenotyping, and activity-tracking data, therapists are able to judiciously refine the timing, dosage, and environmental contextual integrity of interventions, while still engaging in narrative-based and client-centered practice. Frameworks emerging from precision rehabilitation research demonstrate a promising avenue toward a responsible form of ethically supported precision interventions that acknowledges an autonomous and inclusive approach [89,95]. In relation to ethical governance and equity, occupational therapists may also serve a translational function in terms of moving global bioethical recommendations (e.g., WHO’s Human Genome Editing: Recommendations) into clinical and community practice [44]. This would involve developing local protocols for informed consent that are proportionate to uncertainty, equity audits for access to emerging therapies, and making space for dialogue about the social meaning of genomic risk within communities. Recent scholarship argues for the need for such applied governance in rehabilitation contexts [45].

To emphasize the potential for genomic science in occupational therapy,

Table 1. Practical pathways for genomic integration in occupational therapy.

Domain	Example of Genomic Tool or Concept	Potential OT Application	Ethical Considerations
Assessment	Whole-genome sequencing, polygenic risk scores	Informing occupational profiles by linking genomic predispositions with functional outcomes (e.g., fatigue, cognitive variability)	Informed consent, probabilistic uncertainty
Intervention Design	Epigenetic profiling, pharmacogenomics	Tailoring activity-based interventions and recovery plans to individual biological responsiveness	Equity of access, non-discrimination
Client and Family Education	Genetic counseling collaboration	Supporting clients in understanding implications of genetic diagnoses for participation, daily routines, and life roles	Narrative ethics, family autonomy
Policy and Advocacy	Population genomics, equity audits	Guiding inclusive practice policies, ensuring fair access to genomic-informed rehabilitation	Justice, solidarity
Professional Development	Genomic literacy, micro-competencies	Integrating genomics into OT curricula and continuing education	Ethical reflexivity, responsible innovation

summarizes ways in which genomics may inform practice, specifically assessment, intervention, and ethical reasoning, within practice. These examples are not intended to create a requirement for some to follow in terms of method, but to illustrate how genomic data (for example whole genome sequencing, epigenetics, and pharmacogenomics) can be used with the client in an embodied and contextualized way in occupational therapy. Table 1 begins to link theoretical bioethical principles with applications to practice, and has implications for exploring how genomics may enhance, rather than detract, from the humanism and justice-based foundations of occupational therapy.

Ultimately, there are important educational and professional considerations. Micro-competencies could be integrated into ongoing professional development and OT curricula, including micro-competencies such as interpreting genetic reports for job/employment related implications, communicating probabilistic findings in accessible, person-centered language, and engaging meaningfully with genetic counselors and bioethicists. These competencies reinforce the transformational link between knowledge in genomics while being ethical to the profession’s core, ensuring occupational therapy is a part of the discussion about equitable, reflexive, and human-centered applications of genomics and ethical inquiry about occupation [96,97].

6. Conclusions

The incorporation of genomics into health care today is not an inflection point that is simply scientific; it reflects a thorough-going re-conceptualization of human biology, hu-man identity, and human moral responsibility. So-called genomic technologies are rapidly evolving from diagnostic applications to interventional genomic editing, and the incorporation of genomic technologies into health therapeutic professions, like occupational therapy, requires a paradigm shift in professional ethics, epistemology, and practice. This integration is not a neutral or inevitable progression; rather, it is a deeply political and philosophical project, situated within contested narratives about what it means to live, to flourish, and to belong in a world increasingly mediated by molecular knowledge. This article has examined the intersection of genomics and occupational therapy through a critical bioethical lens, highlighting how emerging genomic paradigms challenge traditional understandings of health, ability, and therapeutic responsibility. It has mapped key ethical concerns, such as consent, equity, and professional identity, while emphasizing the importance of resisting reductionist narratives and preserving relational, person-centered care. By bringing together insights from bioethics, science and technology studies, and occupational science, the analysis contributes a theoretically grounded framework for understanding how genomic knowledge can be ethically integrated into OT practice.

In the field of occupational therapy, this genomic turn presents both a challenge and a potential opening. It challenges the profession to remain true to its values in light of the epistemological pressures of biomedical reductionism, while also affording OT an opportunity to carve out its own distinct place at the interdisciplinary table regarding how care will be operationalized. Engaging with genomic evidence critically and reflexively offers occupational therapists the opportunity to advocate for an occupational therapy practice framework that values complexity, contingency, and the lived experience of human beings over deterministic ideologies of use-in-practice evaluating our interventions and research impact. The shift toward genomic integration into occupational therapy must be driven by more than technical feasibility, market demand, and institutional inertia, but rather, by an ethical standing commitment to flourishing diversity of bodies, minds, and modes of being. This means rejecting narratives of pathology in biological variation or superiority of predictive value over lived experience, and adopting a framework for Super-Human potential that are is often hidden under the guise of precision.