The role of an ethics committee in a rehabilitation setting

The ethics committee, initially developed in the acute care setting, can serve to address the particular issues and difficult dilemmas that characterize rehabilitation. The same mechanisms of educational programs, policy development, and case consultation serve to address ethical issues in rehabilitation as well as acute care settings. However, ethical issues in rehabilitation differ greatly from those common in acute care settings. Rehabilitation ethics committees must be prepared to consider issues that include the following: procurement of informed consent for services that are rarely discrete, variable levels of program participation, complex cost-benefit analyses that are subject to less relevant values and biases, unequal access to services, limits of confidentiality, and family/caregiver issues. These difficult issues, peculiar to rehabilitation and made much more complex when patients exhibit cognitive deficits, provide an opportunity for rigorously testing the utility of ethical theory in a complex medical arena.