Ethical issues identified by rehabilitation clinicians

Kirschner KL, Stocking C, Wagner LB, Foye SJ, Siegler M. Ethical issues identified by rehabilitation clinicians. Arch Phys Med Rehabil 2001;82 Suppl 2:S2-8. Objectives: To quantify systematically and to characterize the range of ethics issues affecting rehabilitation professionals' day-to-day clinical practice, and to assess the preferences of rehabilitation clinicians for ethics education. Design: Survey of clinicians and admitting office personnel in an acute rehabilitation hospital with open-ended questions about the ethical issues they found most troubling in daily practice. Setting: A 175-bed free-standing, urban rehabilitation hospital. Participants: A total of 411 clinicians and admitting office personnel, of whom 217 responded (53%) and generated a total of 547 ethics issues. Interventions: Not applicable. Main Outcome Measures: Ethical issues were coded by 2 independent raters into 24 different categories and a reconciliation session was used to resolve discrepancies. Results: The largest response (24%) was categorized as pressures resulting from health care reimbursement changes. The second most common problem (17%) involved conflicts among patients, physicians, team members, or families around goal setting. Difficulty assessing decision-making capacity was third (7%). The respondents favored discussion groups or interdisciplinary inservices and lectures over self-instructional materials as formats for ethics education. Conclusions: Ethical issues in the rehabilitation setting are common, and reflect both the dynamic nature of the health care environment and the team model of care. Ongoing, interactive educational interventions are warranted to address these issues. © 2001 by the American Congress of Rehabilitation Medicine