Occupational therapy (OT) advocates for rehabilitation and social reintegration within prison systems, yet its integration must consider the ethical and institutional constraints of incarceration. This paper critically examines the Spanish penitentiary system to explore the tensions between the punitive logic of imprisonment and the rehabilitative values of OT. The aim is to assess whether the current institutional structure enables socio-health professionals—particularly occupational therapists—to act coherently with their humanistic and ethical principles. A detailed documentary review was conducted using the Triangular Method of Ontologically Grounded Personalism (Sgreccia), which integrates biological/situational, anthropological, and ethical dimensions. Legislative documents, institutional reports, and academic literature were systematically analyzed to identify ethical challenges affecting professional practice within Spanish prisons. Findings reveal a paradoxical reality: Spain maintains one of the lowest crime rates in the EU yet exhibits a high incarceration rate, reflecting a punitive penal culture. The prison population, mostly adult males convicted of property and public health offenses, experiences significant occupational deprivation, mental illness, and social vulnerability. Ethical dilemmas include dual loyalty, loss of autonomy, and institutional priorities that undermine person-centered rehabilitation. The study underscores profound ethical tensions limiting OT practice in prisons. Addressing these challenges requires institutional and professional transformation toward more participatory and dignity-centered correctional models. Future research should incorporate empirical and qualitative approaches to design ethical frameworks that promote occupational justice and sustainable reintegration.

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.

Ethical conflicts are an inherent—yet often invisible—dimension of occupational therapy practice. Most available evidence remains qualitative or conceptual, and the empirical articulation of ethical conflicts in Spain is still limited. This study examines the nature, distribution, co-occurrence patterns, and meanings of ethical conflicts reported by occupational therapists in Spain. A concurrent convergent mixed-methods design was used. From a broader national sample of 596 valid responses, the analytical sample consisted of 160 practitioners (84.4% women, reflecting the gender composition of the profession in Spain) who reported having experienced ethical conflicts and provided open-text information. Data were collected via an online questionnaire combining closed items and open-ended narratives. Quantitative analyses included descriptive statistics and Jaccard-based co-occurrence estimates derived from a non-mutually exclusive thematic coding matrix. Narratives were analyzed inductively with a descriptive phenomenological orientation (Giorgi), using thematic procedures as an analytic scaffold (Braun and Clarke). Findings were integrated through joint displays and meta-inference. The most frequently selected primary conflict categories concerned professional competence and practice (19.4%), relationships with family members/caregivers (14.4%), and the user–therapist relationship (12.5%). Co-occurrence analysis indicated that conflicts rarely occurred in isolation and tended to cluster across relational, structural, and professional domains. Integration of quantitative patterns and narrative meanings supported a preliminary interpretive three-dimensional framework (relational, structural, professional) for understanding ethical tensions in practice. Across narratives, participants described experiences interpreted as consistent with moral distress, economic and workload pressures, limited professional recognition, and normative gaps. Ethical conflicts in occupational therapy practice in Spain are best understood as recurrent, situated tensions shaped by relational dynamics and organizational conditions, rather than isolated dilemmas. Supporting moral agency requires organizational supports, spaces for collective ethical deliberation, and context-sensitive ethics education.