S-1-11-05
LEGAL RIGHTS: PATIENT AND FAMILY
Ellen W. Grabois, J.D., LL.M. (Baylor College of Medicine, Houston, TX)
Physical Medicine and rehabilitation has always emphasized the physical, psycho- social and emotional well-being of the patient. Each individual is encouraged in rehabilitation to attain his or her highest possible level of functional independence given the constraints imposed by illness or injury. In the United States, rehabilitation patients are competent, i.e. those that can make a reasoned decision about their medical treatment, must be fully informed by the rehabilitation physician as to the diagnosis of the illness or injury, the nature and the purpose of the proposed treatment, the risks of treatment, the probability of success of the treatment and the treatment alternatives. This is the doctrine of informed consent. Family members can be support as the competent patient makes his or her own decision regarding what treatment to undergo. In the United States, if the patient is incompetent, i.e. cannot make an informed, rational and knowing decision, family members may be needed as surrogate decision-makers. The surrogate is one who makes a medical decision on behalf of another person. If the surrogate is court-appointed, he or she becomes the patient's guardian. Family members can also be proxies, i.e. they are selected before a patient becomes incompetent to act as a surrogate. Living wills and durable powers of attorney for health care are mechanisms in the United States for patients to designate what treatments they do and do not want, and who will be the decision-maker. These mechanisms are governed by state statues, and can vary from jurisdiction to jurisdiction.
S-1-11-06
DATA-BASE AND OUTOCMES RESEARCH SECURE ETHICALLY SOUND DECISIONS IN MEDICAL REHABILITATION
Nakamura R. (National Rehabilitation Center for the Disabled, Tokorozawa, Japan)
Medical ethics is defined as the values and guideline governing decisions in medical practice. Although there is no socially defined conception of the good that should be imposed on individuals, value judgments in health care are mainly related to happiness, freedom and fairness. At present the issues of medical paternalism VS. patient's autonomy are foremost to physicians. For instance, how is it that decision-making of physician, patient and relatives about goal setting proceed? The collation of both the factual proposition based on outcomes research and the ethical proposition pertained to value judgment provides important means for the process among them. Using data-base of stroke inpatients and multivariate analysis, we can predict their functional status at set times after starting medical rehabilitation and their discharge destination. Also studies on the relation between functional status and daily life events of stroke outpatients revealed the ecological validity of such measures. Those informations secure ethically sound decisions in medical rehabilitation.
