Making Choices from the Choices we have: The Contextual-Embeddedness of Occupational Choice

Abstract

Background. “Choice” is central to occupational therapy’s theoretical tradition, which maintains that individuals can impact their well-being through wisely choosing their occupations. However, the assumption that opportunities to choose are universally available is negated by research evidence. Purpose. To review the ideology of “choice” in occupational therapy theory, and to encourage more critical approaches toward determinants of occupational opportunity and choice. Key Issues. Evidence indicates that within Canada, and throughout the world, opportunities to make occupational choices are inequitably distributed among people of different socioeconomic classes, castes, genders, races, abilities, sexualities, citizenship statuses, and experiences of colonialism. Implications. Because occupation is a determinant of health and well-being, social injustices that create inequitable occupational choices are unfair violations of occupational rights. The occupational therapy profession’s espoused aim of enhancing well-being through occupation demands theories that explicitly recognize the socially structured and inequitable shaping of choice, and consequent impact on people’s occupational rights.

Building back better: Imagining an occupational therapy for a post‐COVID‐19 world

“…Occupational therapy could be deeply rooted in a commitment to expanding people's just and equitable opportunities to engage in meaningful occupations that contribute positively to their own wellbeing and the wellbeing of their communities; and by “people”, this paper is referring, not to “people with impairments and illnesses”, but to people; any people. Contrary to the Occupational Therapy Australia ( 2021 ) declaration of occupational therapy's mandate, our literature reveals a profession preoccupied with assessing and addressing the occupational performance deficits of people with impairments or ill health, with little attention paid to promoting their wellbeing and even less attention directed to promoting wellbeing among the wider population (Hammell, 2020b ).…”

“…If the occupational therapy profession is going to have an evidence‐informed, actionable knowledge base from which to educate students, our research will need to be sophisticated in its capacity to identify the social determinants of occupation and the impact of inequities on people's unconditional occupational rights (Hammell, 2020b ). Moreover, by studying the interconnectedness of occupations, health, wellbeing, and the health of the natural world, occupational therapy will be positioned to contribute a valuable, occupational perspective to global initiatives on human rights, environmental degradation, and climate change (Hammell, 2021 ).…”

“…Neoliberalism is a particular form of globalised capitalism that prioritises free markets, private businesses, and the consumerism that fuels private profits. In the service of this neoliberal agenda, governments cut taxes for corporations and the wealthy, reduce spending on the social programmes that assist those forced to the margins, privatise public resources and services, depress wages and worker benefits, and slash the regulations and oversights that constrain the ability of private businesses to maximise profits (Esposito & Perez, 2014 ; Hammell, 2020a , 2020b ). Neoliberalism is regarded by scholars as being a form of covert colonialism (e.g., Gruber & Scherling, 2020 ; Pihama, 2019 ) that effectively entrenches existing inequities of power and perpetuates White dominance.…”

“…Congruent with its neoliberal underpinnings, occupational therapy reinforces the notion of clients as consumers, asserting that individuals autonomously choose and shape their everyday occupations and that occupational choice is the product of individual volition and rational deliberation (for discussion, see Hammell, 2020b ). Yet, research evidence makes clear: opportunities to choose and to act are inequitably distributed, and inequities that constrain the occupational choices of some groups of people effectively enhance the occupational choices and advantages of privileged group members, as they are intended to do (Frier et al, 2017 ; Hammell, 2020b ). Inequities are not a consequence of happenstance, and because they are avoidable, inequities are manifestly unfair.…”

“…Wellbeing is not an individual concern but rather a collective phenomenon (Hammell, 2020b ). Belonging is central to wellbeing, such that the wellbeing of families, communities, and cultures is integral to individual wellbeing.…”