There are times when an occupational therapist is involved in an ethical dilemma and feels reluctant or uncomfortable. Feeling challenged or not, occupational therapy (OT) practice decisions must be informed by conscious-decision making. The following examines Conscious Decision-Making in Occupational Therapy Practice located on the College of Occupational Therapists of Ontario's (COTO) website. However, occupational therapists must follow the recommended guidelines provided by their provincially registered College of Occupational Therapists. According to COTO, a conscious practitioner: understands the standards and guidlines of OT practice. makes good choices deliberately recognizes his/her/their strengths and weaknesses can reason their course of action There are eight steps in the Conscious Decision-Making Framework, summarized below. Describe the situation: Therapists need to determine all of the client-related relevant information. This may include the scope of the referral, facts about the client, their situation or issues, and other stakeholders. Identify relevant principles: this may include any other College-related documents or ethical principles such as client-centred practice and respect for autonomy. Identify relevant resources: are there any regulatory guidelines that need to be followed? (e.g. consent, record keeping, professional boundaries or conflicts of interest) Further information: may involve discussions with other professional practice team members to examine other literature or research evidence. Identify possible options: there may be only one option, but often there are many. Choose the best option: Critically evaluate the options. Take action: Select and act on the best approach for the given situation. Evaluate the decision: What is and is not working? Reference: Conscious Decision-Making in Occupational Therapy Practice. (2012). https://www.coto.org/resources/conscious-decision-making-in-occupational-therapy-practice.