title: Spinal cord injury medicine. 6. Economic and societal issues in spinal cord injury.
abstract: This self-directed learning module presents a variety of social and economic issues facing people with spinal cord injury (SCI). It is part of the study guide on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on the economic consequences of SCI, ethical issues in SCI, and the legislative efforts that have improved access and quality of life for people with disabilities. Costs of SCI include direct health care expenditures and lost earnings as a result of unemployment after SCI. Lifelong costs can be anticipated with the development of a comprehensive life care plan. Barriers to vocational reintegration continue to limit full participation for most people with SCI. Ethical issues central to SCI are related to the principles of autonomy and justice. As cure research becomes clinically applicable, the SCI community must work together to develop appropriate procedures to respect moral decision-making by all parties. Key legislation in the past century has resulted in important advances in the rights of people with disabilities.
  
  
  OBJECTIVE
  (a) To review the economic consequences of spinal cord injury, including lifelong direct costs, life care planning, and factors affecting employment and (b) to identify current ethical issues facing the spinal cord injury community and review the advances made in the rights of people with disabilities in the United States through legislation.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA. priebe.michael2@mayo.edu <priebe.michael2@mayo.edu>
authors.forename: Michael M
authors.initials: MM
authors.lastname: Priebe
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Chiodo
authors.forename: William M
authors.initials: WM
authors.lastname: Scelza
authors.forename: Steven C
authors.initials: SC
authors.lastname: Kirshblum
authors.forename: Lisa-Ann
authors.initials: LA
authors.lastname: Wuermser
authors.forename: Chester H
authors.initials: CH
authors.lastname: Ho
mesh_terms: D017281:Cost of Illness; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000331:legislation & jurisprudence*; D004651:Employment; D006801:Humans; D010358:Patient Participation / Q000523:psychology*; D011788:Quality of Life; D012931:Social Environment; D013119:Spinal Cord Injuries / Q000191:economics* / Q000523:psychology* / Q000534:rehabilitation