Scenario: You are an OT working with a client that has been experiencing severe spasticity that

has been causing him severe pain and limiting his functional abilities. His spasms have not
responded to modalities or medications. He discloses to you that he smoked marijuana that his
friend brought in to the hospital this morning and he finally feels some relief from his spasticity.
This is the best he’s felt since his spinal cord injury. You tell him that regretfully, you need to
tell the doctor that he took an unprescribed substance. Your client begins to cry and begs you not
to. He disclosed this information to you because he thinks of you as a friend and trusted that you
wouldn’t tell anyone. On top of the stress from his new spinal cord injury, now he is worried that
he may be in legal trouble because you are going to tell the doctor.

* What makes this situation an ethical dilemma?

There is conflict between what the client wants and what I am bound to do as part of his
healthcare team. An important part of being an effective OT practitioner is developing
trust in the relationship with the client. Reporting his use can lose that trust.
The marijuana was helpful for him and he may not be able to continue using it if medical
marijuana is not legal in the state or cannot be prescribed for him for some reason. There
would also be concern about causing further stress for the client worrying about legal
issues. However, the doctor needs to know what substances the client is taking in order to
provide the best care, so I am under an ethical obligation to report that. There could also
be professional repercussions for me if I do not report this information to the doctor.

* Using the AOTA code of ethics, state which principles apply and why. Who are the parties
concerned?

Beneficence - I should take action to benefit my clients.

Autonomy - the client has the right to self-determination. His choice to use marijuana
may be considered under this principle.
Veracity - I have a responsibility to disclose relevant information about my client to the
doctor.

Those concerned are the client, the doctor, others on the medical team, the facility, and
the OT.

* What is the nature of their interest and why are they concerned?

Client - worried about legal consequences for himself and perhaps his friend; no longer
able to get the symptom relief that marijuana gave him.
Doctor - needs to know what substances the client is taking in order to provide the best
care for the client.
Others on the team – changes in spasticity from using marijuana would be important
information for the nurse, PT, and others who work with the client.
OT - concern of losing trust with client, impacts to the client’s well-being due to
additional stress from the situation, concern that the client may lose an option that was
providing him relief.
 Facility - they would have a responsibility to keep illegal substances out of the hospital.

* What other information is needed before action is taken?

I would want to know if there would be any legal repercussions so that I could let the
client know what to expect. I actually do not think any legal action would be taken
against the client, so getting that information would help me alleviate his concerns in that
area.

* What are your choices? For each choice indicate possible consequences.

Do not report the marijuana use: If he continues using marijuana and that information is
not shared with his doctor and healthcare team it could impact the treatment he gets. His
long-term care plan could be impacted because if the spasticity is masked during his
hospital stay due to marijuana use, it will not be adequately addressed. I could also face
professional repercussions for not reporting this.

Report his use: The client may not feel he can work with me as his OT. His spasticity
may continue without using marijuana, reducing his functional progress and quality of
life. However, a long-term plan to manage the spasticity without use of marijuana could
be assessed and implemented. Additionally, if this took place in a state where medical
marijuana is legal, the doctor may assess if it is appropriate to add marijuana to
his treatment plan, which is a better option for the patient that taking the substance
illegally.

* Name 2 professional organizations or systems can assist in resolving professional ethical

disputes (your answers must reflect systems that have jurisdiction over OT practice).

• AOTA Ethics Commission

• Ethics Committees in hospitals