ABSTRACT
In 2003, we led a working conference on leadership in ethics education for physical therapy and occupational therapy entitled, "Dreamcatchers and the Common Good: Allied Health Leadership in Generational Health and Ethics." The institute brought together 25 leaders in ethics education in physical therapy and occupational therapy for a 3-day working conference of experts. In this paper, we discuss our work as part of an interdisciplinary community of ethics educators who have been grappling with ethics education in rehabilitation over the last 7 years. We reflect on our collaborative work and then propose components of a moral foundation required for continued interprofessional dialogue and work.
Subject(s)
Ethics, Professional , Interdisciplinary Studies , Occupational Therapy/education , Occupational Therapy/ethics , Physical Therapists/education , Physical Therapists/ethics , Congresses as Topic , Cooperative Behavior , Humans , United StatesABSTRACT
Innovative technologies are rapidly emerging that offer caregivers the support and means to assist older adults with cognitive impairment to continue living "at home." Technology research and development efforts applied to older adults with dementia invoke special grant review and institutional review board concerns, to ensure not only safe but also ethically appropriate interventions. Evidence is emerging, however, that tensions are growing between innovators and reviewers. Reviewers with antitechnology biases are in a position to stifle needed innovation. Technology developers who fail to understand the clinical and caregiving aspects of dementia may design applications that are not in alignment with users' capabilities. To bridge this divide, we offer an analysis of the ethical issues surrounding home monitoring, a model framework, and ethical guidelines for technology research and development for persons with Alzheimer's disease and their caregivers.
ABSTRACT
Good end-of-life care requires that clinicians, families, and ethicists be aware of biases that influence patient cases, particularly in the acute care setting where the aim is primarily cure and return to optimal functional level. Persons with disabilities may pose unique challenges; their potential for quality of life is viewed through the lens of highly functional clinicians who might have a biased view of the disabled person's quality of life. The authors aim to present three categories of disability that do not claim to be absolute but rather offer clinicians and ethicists a lens through which to reflect on bias that unconsciously may influence their approach to the patient who is seriously ill and may be nearing the end of life. The categories include (a) a person who has lived with a disability from birth or early life, due to trauma or disease, and is now faced with a serious illness that requires that life-sustaining treatment; (b) the otherwise healthy person who acquires a disability through an acute event of disease or trauma and whose condition requires that life-sustaining treatment decisions be made; and (c) the person who has lived with a progressive chronic illness, such as lung or heart disease or amyotrophic lateral sclerosis, and may have gradually adjusted to disabilities imposed by the condition and now is faced with life-sustaining treatment decisions. The concept of inherent dignity (Pellegrino 2005) is suggested as a filtering lens in case consideration.
Subject(s)
Decision Making , Disabled Persons/psychology , Terminal Care/ethics , Aged , Female , Humans , Male , Middle Aged , Personal Autonomy , PersonalitySubject(s)
Medical Errors/psychology , Physical Therapy Specialty/standards , Professional-Patient Relations , Truth Disclosure , Attitude of Health Personnel , Compensation and Redress/ethics , Denial, Psychological , Grief , Humans , Medical Errors/ethics , Medical Errors/prevention & control , Physical Therapy Specialty/education , Physical Therapy Specialty/ethics , Professional Autonomy , Professional-Patient Relations/ethics , Truth Disclosure/ethicsABSTRACT
Substantial progress has been made in developing treatments that reduce the risk of fractures in osteoporosis. However, available treatments are only partially effective, they are not widely used, and there is need to search for more effective means of fracture prevention. Currently known effective means of reducing fractures were found using randomized placebo-controlled trials. The use of placebo controls in clinical trials has been a subject of significant controversy in recent years. The Declaration of Helsinki revision of October 2000 caused great concern among clinical investigators about the future use of placebo controls if known effective therapeutic agents are available. A working group of ethicists, clinical trial design experts, and clinical investigators examined the current state of knowledge of osteoporosis treatment and trials. They concluded that if placebo controls put subjects at substantial risk of serious outcomes, they are not ethically permissible. Placebo controls in osteoporosis trials with fracture as the measured outcome are permissible only under narrowly defined conditions. Placebo controls may be used if competent, well-informed patients refuse approved therapies for sound reasons, there is a reasonable basis for substantial disagreement or lack of consensus among professionals about whether approved treatments are better than placebos, or subjects are refractory to known effective agents. Active control trials are permissible and desirable if they can be designed and conducted in ways that overcome the interpretive difficulties often associated with such trials.
