S-1-11-07
TRAUMATIC BRAIN INJURY REHABILITATION - ETHICAL CONSIDERATIONS
Zeev Groswasser (Loewenstein Rehabilitation Hospital, Ra'anana, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
Surviving traumatic brain injury (TBI)patients pause special problems to the medical world. During the acute phase of trauma, while the patient is sometimes in deep coma, flaccid and with dilated pupils, discontinuation of active treatment is sometimes considered. Introducing prognostic factors into treatment protocols further complicates decision making regarding allocation of resources. The "Outcome Movement", the need to be successful, and the pressure of health care providers, influence to a greater extent decisions regarding who should be admitted for rehabilitation, as well as duration of treatment. Intrinsic administrative/economic pressures from within the medical have also a greater influence on medical decisions.
The ethical and moral dilemma with which the rehabilitation physician is confronted to-day are more complex than ever. Rehabilitation medicine, which is mostly concerned with the quality of life of patients. The trend to convert patients to clients, the increasing costs of medicine, and the trend of social decision makings to allocate fuel resources, cast a gloomy light on future chances of rehabilitation medicine to fulfill its goals.
Seminar-1-01-01
REHABILITATION - A COPING PROCESS
Axel R. Fugl-Meyer (Department of Rehabilitation Medicine, Uppsala University, Uppsala, Sweden)
In rehabilitation medicine two very different paradigms co-exist. A biostatic one which regards man as a (potential) bearer of symptoms. The other is a holistic paradigm that regards man as an acting subject. This presentation is built upon the concept that each person is unique and acts intentionally through confirmatory or exploratory actions in order to reach his (vital) goals. Within this framework a person who is at health has the knowledge that he can reach his realistic goals. The patients seen and treated by rehabilitation staffs are those who, due to impairment(s), believe that they have become disabled (i.e. have lost activity repertoires). Most actions are no more confirmative, but have become exploratory. This is experienced as an existential threat, which imposes high demands on coping resources. Rehabilitation is, therefore, a coping process that aims to support an individual to grow psychologically using pedagogic, psychologic, social and physical interventions, avoiding a pure biologic strategy. After all, impairments may be looked upon merely as changes of physical circumstances.
