Ethical issues and the patient-provider relationship

In enabling disabled persons to gain increased function and independence, rehabilitation practitioners try to emphasize the patient's goals by providing the patient with some control over the process. As the patient enters the active rehabilitation phase, the patient actively becomes involved with the design of the treatment plan. If the patient does not fully participate in this plan, his/her motivation may be questioned. Rehabilitation professionals prefer patients who comply with the original treatment plan. Conflicts arise when patients do not comply, and the war between patient autonomy and medical paternalism ensues. When the disabled person becomes an outpatient, we must learn to measure the quality of life, not just the functional outcome. Rehabilitation professionals have become masters of inpatient rehabilitation but are less prepared to facilitate comprehensive rehabilitation care in the outpatient setting. Outpatient rehabilitation also needs to measure community reintegration. In the continuum of chronic disability, the care-giver and the disabled person develop an intermittent interdependence with an alternating relationship between autonomy and paternalism. Mutal respect such as that experienced in friendship provides a useful model for this idealized patient-care enabler team. To understand more of the essence of the disabled person's life is the responsibility of the rehabilitation provider.