Describe a situation 

where ethical issues played a role. What ethical principle(s) are

applicable to this situation? Who are the parties involved?  How is the situation being
handled?  Would you do anything different if you were the licensed OT? Describe what
you would do.
During my first Level II fieldwork, I worked with a young patient who was planning to
discharge from inpatient rehab to home. She had been in the hospital for several months,
following a vaping induced lung injury. The patient and her mother wanted to leave and
go home at all costs, on a date that was tentatively thrown out for her potential
discharge. In team conferences with members from all of the health care disciplines (MD,
Nursing, PT, OT, SLP, Respiratory Therapy, Education, Rehab Psych) leading up to the
date, however, everyone expressed that it was not feasible or safe given her condition,
and the amount of suction/O2/nursing cares she still needed. When the doctor relayed
this information to the patient and her mother, instead recommending a LTAC or SNF
discharge, they were extremely upset and risk management had to get involved. They
expressed that they felt their desires/hopes for the situation weren't being considered
(i.e. they had been in the hospital for over half a year, the mom had to take time off from
her job with FMLA benefits expiring and so she felt a burden to get back to work to
relieve the financial pressure they are under, the patient had already been in an LTAC
and her mother felt that she could provide better care for her daughter at home than in
an LTAC).  Several ethical principles related to this case are autonomy and beneficence. 
Ultimately the patient has the right to make a determination regarding care decisions
that directly affect her life. At the same time, under the OT code of ethics, we are
responsible to prevent and remove harm, as well as to act to protect patients from
dangerous situations. My CI and other members of the health care team stated that they
didn't feel comfortable signing their licenses off on discharging this patient, but if the
patient left against medical advice, she and her family would be responsible for all of her
rehab stay and she would not be able to get the equipment she needs to complete
BADLs covered. 
Ultimately, everyone documented their concerns and the education that the patient and
her mother were provided with, and she was discharged to home. In the future if this
happens to me as a practicing therapist, I will work with the team and ensure that my
documentation is solid and includes all important aspects of my care/education
provided, so that if something goes awry when the patient leaves, my bases are
covered. 
This was a difficult situation to navigate because there were strong emotions coming
from both sides (family and medical team). It was beneficial for my learning to be a part
of the team and to see how this ethical conflict was communicated between everyone
involved.