Access to Care for Persons With Brain Injury: Ethical Frameworks to Promote Health Systems Change.

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Bioethics

Background:

• Individuals with brain injuries face significant challenges in accessing long-term healthcare services.
• Healthcare systems often prioritize cost containment, creating barriers for survivors with complex, ongoing needs.
• The focus on medical necessity and managed care can neglect the holistic needs of brain injury survivors.

Purpose of the Study:

• To highlight critical neuroethical considerations in the rehabilitation of brain injury survivors.
• To explicate the difficulties in providing longitudinal healthcare services for individuals with chronic brain injuries.
• To analyze the intersection of personhood, rehabilitation systems, and the medical model in brain injury care.

Main Methods:

• Inductive analysis of rehabilitation experiences from two brain injury survivors.
• Application of three ethical frameworks: teleological implications in rehabilitation, care ethics (feminist and disability ethics), and pragmatism/dehumanization literature.
• Drawing upon research on healthcare provision in the Commonwealth of Virginia.

Main Results:

• Current healthcare practices pose significant challenges to meeting the long-term needs of individuals with chronic brain injuries.
• Neuroethical considerations reveal tensions between the medical model and the holistic needs of survivors.
• The study identifies systemic issues that can lead to dehumanization within the rehabilitation system.

Conclusions:

• There is a critical need to address the neuroethical challenges in providing continuous, person-centered care for brain injury survivors.
• Rehabilitation medicine must integrate care ethics and pragmatic approaches to overcome systemic barriers.
• Healthcare systems require reform to better support individuals with long-term needs arising from brain injuries.