Unsustainable lifestyles contribute to global greenhouse gas emissions and climate change. The growing recognition of this negative impact on the earth’s ecosystems and human health and well-being compels occupational therapy practitioners to address environmental sustainability issues. Western contextual factors present obstacles to the adoption of ecologically beneficial practices in occupational therapy. Resolving these ethical challenges through the use of multiple epistemologies may yield novel solutions and usher in the adoption of ecologically sustainable occupational therapy in the United States. In this column, I explore some of the contextual factors that influence occupational therapy theory and practice as they relate to ecological sustainability. I also briefly discuss some non-Western cultural perspectives, challenges to integrating ecological ethics into occupational therapy practice in the United States, and ways individual occupational therapy practitioners and state and national organizations can begin to address this issue.