Ethical issues identified by rehabilitation clinicians.
OBJECTIVE
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.


METHODS
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.


METHODS
A 175-bed free-standing, urban rehabilitation hospital.


METHODS
A total of 411 clinicians and admitting office personnel, of whom 217 responded (53%) and generated a total of 547 ethics issues.


METHODS
Not applicable.


METHODS
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 in-services 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.
Kirschner
K L
KL
Department of Physical Medicine and Rehabilitation, Northwestern University Medical School and The Rehabilitation Institute of Chicago, Chicago, IL 60611, USA.
Stocking
C
C
Wagner
L B
LB
Foye
S J
SJ
Siegler
M
M
D000328:Adult; D003219:Confidentiality; D004992:Ethics, Medical; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007087:Illinois; D008297:Male; D010348:Patient Care Team / Q000592:standards; D010810:Physical and Rehabilitation Medicine / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012047:Rehabilitation Centers / Q000592:standards*; D011795:Surveys and Questionnaires; D014505:Urban Population