Introduction
In the last 20 years, there has been an enormous boost in the understanding of ethical concerns and problems in the medical career. A lot of such concerns have involved severe and evolving issues like life and death choices during a severe sickness or pain.
Until more lately, the dilemmas associated with chronic diseases, and more particularly associated with rehabilitation-based concerns, have received comparatively little consideration.
A number of articles started to address ethics in rehabilitation healthcare or permanent care since 1980s (Caplan, 1988; Jeff, 2000). However, there were no actual corrective interactions at that time between rehabilitation professionals and ethicists.
The initial key identification of ethics in the context of rehabilitation healthcare, based on Caplan (1988) most likely happened from 1984 to 1986, when the Hastings Facility formed a working team with a view of examining ethical measures of rehabilitation.
This was the first time that an organization of specialists who were particularly interested in ethical concerns had explored dilemmas related to constant care and rehabilitation (Caplan, 1988).
Since the 1990s, there has been an incredible boost in the number of literature relating to different ethical problems that happen, particularly in the setting of rehabilitation healthcare.
The objective of this paper is that of providing an overview of the most important ethical practices in addition to a number of detailed examples of moral concerns that might occur on a daily basis to the rehabilitation specialist.
Overview
It can at times be rather hard to identify whether specific actions are or are not ethically right. However, if people can concur that certain actions are not right, it will probably have relationships with other incorrect activities.
When attempting to identify what such joint aspects might be, people establish moral standards that they then test and utilize across an array of concerns and cases.
These standards ought to enable rehabilitation specialists to assume an unswerving position on particular and associated concerns. Three ethical standards serve as an outline for medical morals: kindness, respect for sovereignty and fairness (Gosney et al., 2011).
Kindness
The word “kindness” signifies charity, the doing of good and humanity. Kindness refers to an ethical responsibility of assisting others, with a view of avoiding hurting them, and to try and balance gains with damages.
In the medical context, kindness implies a responsibility of promoting the health and fitness of the patient and to prevent pain, illness, harm and distress (Buhrman et al., 2010).
Respect for sovereignty
In ethical practice, sovereignty refers to independence, or the autonomy of the self. Individuals must have sufficient knowledge and not be manipulated by other people or by specific barriers that limit options (Jeff, 2000).
When medical practitioners respect patients as self-governing, they recognize their right to share opinions, make decisions and take action based on their own values and wishes.
People have to be given the ethical right to make their own decisions and implement them (LaDou, 2006).
Fairness
A person is treated based on the standard of fairness if he or she is handled based on what is reasonable, appropriate or suitable (Thorsten et al., 2006).
The theory of fairness involves the query of what is appropriate to whom, and how to share the gains and demerits of living in a certain community (Gosney et al., 2011).
Ethical choices are carried out on a day-to-day basis in the area of rehabilitation medication. Some of these are trivial issues like the choice of explaining the threats and get permission for shared injections or diagnostic procedures.
Other issues, however, are more compound and hard, and may involve the input of many diverse stakeholders. A number of concerns are quite particular to the field.
Bearing in mind the moral standards just described, moral concerns in two contexts normally encountered in community-based rehabilitation centre will be highlighted: patient choice and resource distribution.
A new issue, the ethics of teamwork, will also be discussed. The purpose is not essentially that of providing strong responses, but that of considering the concerns and the many options that may be explored with a view of making decision-making rather easier.
Patient choice and resource distribution
The choice of patients who are to be included in a community-based rehabilitation program is usually carried out by the medical practitioner.
Since in numerous programs, demand for inclusion surpasses the number of available bed spaces, hard choices frequently must be executed.
In certain instances, there may be an evidently described set of practices available, but decisions are frequently more biased.
Purtilo (1988) argues that patient choice needs contemplation of not only medical but also non-medical aspects. Medical aspects comprise diagnosis, working performance, related obstacles, prognosis and capability of learning.
Non-medical aspects can be socio-cultural, professional, individual and economic. Other aspects might as well be considered. Changes in bed space accessibility might influence decision-making.
A patient with tentative diagnosis might be declined if there is an extended waiting record, whereas that same patient might be admitted if a bed was vacant at that time.
In a community-based rehabilitation, program-specific requirements like the requirement for respiratory system, might affect decision-making.
It has to be noted that not all individuals who are recommended for psychological test will gain from rehabilitation; this is why a patient has to be vetted.
Even though the therapy procedure utilizes a group strategy, the final choice is often carried out by a medical practitioner, frequently with less contribution from team participants.
The role of choosing people for therapy can generate different ethical issues. The right, duty and obligation of both a patient and a practitioner must be taken into account. As described, there is the possibility that the procedure will be too biased – hence the likelihood for unfairness.
The levels of kindness and functional fairness have to be integrated, and may at times be at odds. The issue of selecting patients and allocating resources is an intricate one.
The medical practitioner must focus on striking a balance between fairness and kindness. In the long term, however, the selection is frequently biased.
Also, it appears realistic to bear the challenge of following that patient who is at first declined with a view of ensuring that his or her case does not at certain level fluctuate.
Identification and discussion
Ethics of teamwork
Due to its focus on optimizing patients’ natural, psychological and socioeconomic fitness and autonomy, community-based rehabilitation program concentrates on teamwork with a view of helping patients attain their goals.
All team members have their own dedicated coaching and obligations, even though there is frequently some misunderstanding.
The focus within rehabilitation is that of trying and developing interdisciplinary rather than multidisciplinary groups, which implies that all members function within the setting of the group, rather than as sovereign members.
The team usually comprises of a medical practitioner, a nurse dedicated to care of the rehabilitation patients, social workers and several rehabilitators, even though team composition may change based on the rehabilitation program and the goal of the group. The patients should also be involved in decision-making and dialogues.
Since all team members are expected to have their own set of ethical practices and principles, it is unexpected that they will decide on all moral questions that arise.
Disagreements between two team participants ought to be handled and resolved within the group setting. It is critical that the group offers constant support to the patients and their families.
If possible, a patient should not be informed about a conflict within the group, because contradictory information can be perplexing and disturbing for patients who are already struggling to live with an emerging disability.
A good instance of poor collaboration influencing medical care in the rehabilitation context includes the procedure of teambuilding.
This refers to the process via which the focus on achieving common ground in the team can result in unsuitable conflict (Buhrman et al., 2010).
Current research
Gosney et al. (2011) propose that with a view of bringing about an indication of ethical desires within a group, four levels have to be followed: the group must establish an ordinary ethical language for dialogue of ethical concerns; a group member must possess realistic and cognitive coaching to articulate his or her emotions regarding certain concerns; value explanation assignments are required and the group has to possess universal familiarities upon which to implement executable ethical practices.
There are two core frameworks of interactions between caregivers and patients: Hippocratic and fiduciary (Thorsten et al., 2006). In the Hippocratic framework, a professional is advised to deal with patients in the manner he or she believes to be most appropriate.
This refers to the mainstream framework of rehabilitation, and offers less contribution to patient sovereignty, with members not contributing towards goal realization.
Buhrman et al. (2010) have challenged that Hippocratic framework is inadequate for community rehabilitation program since the need varies so much from mainstream severe care rehabilitation.
It includes several specialists, occurs in some contexts over an extended period of time and includes relatives in dynamic positions. Due to such aspects, Buhrman et al. have suggested a fiduciary framework of interaction, which considers the need for time to enable a patient to cope with the certainty of an acute disability.
The best option of resolving disagreement in the team between a patient and other group participants is generally via precise and transparent communication. If the patients are skilled, their desires have to succeed.
On the other hand, it may be realistic to persuade the patients with a view of considering the values of their social model and the effect of their choice on relatives (Gosney et al., 2011). Further research is required to redefine the core aspects of the relationship between care givers and patients.
Conclusion
The research on moral concerns in community based rehabilitation setting is a comparatively fresh field, one in which precise and simple responses are not frequently available.
The aspects of sovereignty, kindness and fairness must all be taken into account, and a focus on striking a balance must be integrated. In this essay, the concerns of resource sharing and teambuilding within the setting of rehabilitation program have been explored.
Finally, the objective of rehabilitation field is that of ensuring patient independence while focusing on giving the best service possible, at the same time taking into account the desires and believes of patients as a whole.
References
Buhrman, M., Nilsson, E., Jannert, M., Lars, S., & Gerhard, A. (2010). Guided internet-based cognitive behavioural treatment for chronic back pain reduces pain catastrophe: A randomized controlled trial. Rehabilitation Medicine, 43(6), 500-505.
Caplan, L. (1988). Informed consent and provider: Patient relationships in rehabilitation medicine. Physical Medicine Rehabilitation, 69(2), 312–317.
Gosney, J., Jan, D., Andrew, J., & Haig, J. (2011). Developing post-disaster physical rehabilitation: Role of the world health organization liaison sub-committee on rehabilitation disaster. Physical and Rehabilitation Medicine, 43(11), 965-968.
Jeff, B. (2000). Ethical issues in rehabilitation medicine. Rehabilitation Medicine, 32(2), 51–55.
LaDou, T. (2006). Current occupational & environmental medicine (4th ed.). New York: McGraw-Hill.
Purtilo, B (1988). Ethical issues in teamwork: The context of rehabilitation. Physical Medicine Rehabilitation, 69(2), 318–322.
Thorsten, M., Deck, R., & Heiner, R. (2006). Problems completing questionnaires on health status in medical rehabilitation patients. Rehabilitation Medicine, 39(8), 633-639.