This chapter provides an introduction to rehabilitation ethics. We begin by presenting a fictitious case study that serves to illustrate how ethical considerations can arise in the context of rehabilitation care (Case Study 93–1). We then briefly define ethics and distinguish it from related concepts, before identifying four key sources of ethical challenge in rehabilitation practice. These ethical challenges are illustrated in reference to the case study. Finally, we canvass ethics resources that can help support the professional judgment of rehabilitation clinicians in situations of ethical uncertainty or disagreement.
Case Study 93–1
Mrs. Belawan is a 65-year-old woman who had a severe stroke 2 months ago. She was recently admitted to a rehabilitation hospital with the goal of improving her function, including her ability to transfer from a wheelchair to and from bed, mobilize independently with her wheelchair, and perform daily personal care tasks. As well as experiencing mobility and self-care limitations, Mrs. Belawan has dysphagia and is at risk of aspirating her food, a situation which could result in her developing pneumonia. Although she has some short-term memory difficulties, she is able to reason and has insight into her situation. She is a widow. Her two adult daughters take turns visiting her every evening.
Due to her dysphagia, Mrs. Belawan has been prescribed a modified diet of thickened liquids and purées. However, she refuses the modified food. She insists that eating is one of the only pleasures left to her, especially the food her daughters prepare using family recipes and bring to her at the hospital. She states that she understands the risks of eating unmodified foods. The team is very concerned by this situation and is unsure how to respond. They are especially concerned about helping to feed Mrs. Belawan when her daughters are not present since they feel that they would be contributing to an extremely dangerous situation.
Arising from its origins as a philosophical discipline, ethics focuses on the elaboration and discussion of right, good, or virtuous actions and the values and principles that underlie them. Ricoeur has expressed that “the aim of ethics is the good life, with and for others, in just institutions.”1 This vision of the purpose of ethics helpfully illustrates some key features of ethics in the context of health care: A central “aim of ethics” is to promote and sustain attitudes, practices, and policies that are judged to be exemplary or laudable.2 Ethics focuses on the “good life”; although there are multiple and competing interpretations of what counts as the right or good way to live.3,4 Ethical frameworks share a commitment to seeking to identify and advance the right and the good, even the virtuous life.5 In health care contexts, the latter parts of the quote from Ricoeur are especially salient. Ethics is particularly concerned with relationships, with what each person owes ...