The foundation and application of ethical principles in rehabilitation psychology.

Abstract

General bioethical principles, such as autonomy, nonmalfeasance, justice, and care, provide the foundation for ethical decision making in health care. Aspiring to uphold the ethical principles is a fluid process, based on advances in health care, social and cultural pressures, and applications of the principles both to specific clinical situations and policy making. In this paper, we review the principles and discuss their application in rehabilitation and in health care. We argue that rehabilitation psychologists have unique expertise to impact ethical decision making at all levels of social structure, and that rehabilitation represents a critical forum in which this role definition of psychologists manifests itself. In addition, the principles themselves, if given substantive meaning in their practical application, can and should drive adaptive legislation in support of rehabilitation and health care goals in developing ethical care alternatives.The development of ethical thought in health care has provided an appropriate scheme for evaluating clinical decision making, professional conduct, policy development, and legislation. Using ethical principles to establish moral groundwork, and as an aspirational rationale for health care, ensures that higher order purposes are the umbrella for both action and evolution in the field. In this paper, we first overview the basic principles from which ethical thought and decision making in health care evolved. We then provide a discussion of the applications of these principles to rehabilitation and the

Substance Abuse Counselors and Ethical Dilemmas: The Influence of Recovery and Education Level

“…The gaps and contradictions in ethical codes require the counselor to have a deeper understanding of the fundamental basis for dealing with ethical dilemmas (Kitchiner, 1984). In essence, when a code fails to provide clear guidance, the professional must make reasonable ethical decisions using the principles upon which critical ethical reasoning is founded: autonomy, beneficence, nonmaleficence, fidelity, and justice (Blackwell et al, 1994;Corey et al, 1993;Howie, Gatens-Robinson, & Rubin, 1992;Kerkhoff, Hanson, Guenther, & Ashkanazi, 1997;Kitchener, 1984;Langford, 1994;Millard & Rubin, 1992;Tarvydas, 1987;Thomas, 1994;Wilson et al, 1990;Wong, 1990).…”

Supporting, Promoting, Respecting and Advocating: A Scoping Study of Rehabilitation Professionals’ Responses to Patient Autonomy

“…The papers included in our review can be grouped into three broad categories related to autonomy: 1) principlist accounts, 2) rights-based and legal analyses, and 3) relational/social approaches; the principlist approach and its application to ethical issues in rehabilitation or to specific cases being the most frequent [14,19,25,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. A common feature of articles drawing upon principlist accounts is to discuss the principle of respect for autonomy in light of other principles, including beneficence, non-maleficence and, less frequently, justice.…”

“…For some individuals, autonomy is limited by a lack of knowledge related to the degree and scope of their impairments, including the extent of their treatment needs [14,16,53], as well as by feelings of ambivalence, expectations that may be unrealizable, or a fear of treatment [65]. Rehabilitation services that include the monitoring of these psychological aspects can help identify opportunities to promote autonomy [8,14,23,25,27,43,50,66], including referral to professionals offering psychosocial support [43], which could include psychologists, social workers, chaplains, and sexologists, among others. Incorporating an awareness of perceptual and emotional factors will also help rehabilitation professionals to promote their patients' decision-making capacities by tailoring their approach to the patients' realities and needs [27,43].…”

“…Rehabilitation services that include the monitoring of these psychological aspects can help identify opportunities to promote autonomy [8,14,23,25,27,43,50,66], including referral to professionals offering psychosocial support [43], which could include psychologists, social workers, chaplains, and sexologists, among others. Incorporating an awareness of perceptual and emotional factors will also help rehabilitation professionals to promote their patients' decision-making capacities by tailoring their approach to the patients' realities and needs [27,43]. For instance, several authors discuss the 'intermittent interdependence model' [14,16,17,27,47,52], which suggests that "individuals have different methods of adjustment, and each phase of rehabilitation generates choices and strategies for maximizing autonomy and participation" [27, p.972].…”

“…Authors have discussed respect for autonomy in relation to enhanced collaboration, consensus and problem solving, and engagement of patients in the decision-making process [10,12,58]. Respecting autonomy also entails engaging with the cultural perspectives of individual patients, including expectations and views related to decision-making, interdependence, dependence and families [27,43,73,74]. For example, in some cultural communities, older adults may be less (or not) involved in decision-making processes about their own health; autonomy may also be understood as being collective [27,73,74].…”