BIOMEDICAL ETHICS IN PHYSICAL MEDICINE AND REHABILITATION
Herman J. Flax, M.D., Veterans Affairs Medical Center, Washington, D.C. USA
Dilemmas in treating the disabled and handicapped are different from acute medical care, especially if the patient is elderly and/or not motivated. Usually, there is loss of physician-patient confidentiality, patient autonomy, and other principles of medical ethics in rehabilitation medicine.
Biomedical ethics is the employment of a set of moral rules by the physiatrist and the members of the ancillary medical team. The ultimate goal of medical rehabilitation is to bring the patient to the point where he/she will be able to participate and voice an opinion in his/her treatment. The Biomedical Ethics Committee is an advisory body, who, upon consultation, assists the attending physician and rehabilitation team to render a valid decision in accord with the preservation of the patient's rights and avoidance of possible future legal involvement.
The Physiatrist's Role in Patient Empowerment
Robert H. Meier, III (O'Hara Regional Center for Rehabilitation, Denver, Colorado)
As more physiatric services are provided on an outpatient basis and the pressure for greater patient care productivity increases, the physiatrist must find new creative ways to empower patients. Patient empowerment should be achieved through: patient and family education, patient inclusion in the treatment decision processes, the provision of therapeutic choices and the patient assumption of independence from health services for the majority of time. Physiatrists, along with the rehabilitation team, should design outpatient educational programs that require less one-on-one time. The use of audiovisual aids, brochures and group sessions can decrease the professional time required. At all times, the patient and/or the family must be included in making therapeutic decisions once they have been educated regarding their choices. Liberating the patient from costly health professional interactions and their services is difficult. Wherever possible, patients need to assume responsibility for altering life practices that are not healthy and turn the practice of wellness behaviors. Cessation of smoking, weight control, good nutrition and regular exercise are examples of behaviors that physiatrists must include routinely in their provision of health services. Mechanisms for follow-up that do not require office visits will also assist in decreasing the costs of health care. These systems of follow-up must also assess outcomes while enhancing freedom for the individual from the traditional health care system.