Ethical and Deontological Problems in Rehabilitation of Persons with Physical Disability
The Minister of Health and Social Welfare outlined in 1969 a program of medical rehabilitation development and recognized medical rehabilitation as an integral part of medical treatment. These decisions ended the voluntary approach of the National Health Service to problems of rehabilitation.
Consequently, ethical and deontological principles adopted in 1967 by the Polish Medical Association need to be revised. It has heretofore been considered a doctor’s duty to prevent incidence of disease. Now this duty has a wider scope and embraces prevention of disability. The doctor was obliged to advise the family of a patient if his condition seemed to be fatal. Now he is obliged also to advise them of the fact that „a patient’s condition may lead to disability”. Every doctor should be morally obliged to initiate rehabilitation for those injured patients who are susceptible to disability, and for those who have actually become disabled. This initiation consists in getting in touch with a rehabilitation specialist, a member of the local Health Care Assembly. The specialist may happen to be employed in the rehabilitation ward of a voivodeship hospital or in an outpatient clinic, or, in some cases, in the specialistic rehabilitation establishments.
Rehabilitation of injured persons is a multi-faceted process which can best be conducted by a rehabilitation team. The rehabilitation team has to be sensitive not only to the medical problems but also to the inter-personal relations of the injured patients as well as to the problems of interaction within the team. The rehabilitation teams will be better able to fulfil their duties if their moral attitudes be highly praiseworthy. We are still not sufficiently aware of the fact that physicians distribute public goods. They prescribe prosthetic apparatus, and implements for the self-care of the disabled, they refer them to rehabilitation sanatorium and make decision on the length of their stay therein. In Disability and Employment Committees physicians evaluate the degree of disability and make decisions concerning the size of benefits. Every activity of a physician involved in rehabilitation has much bearing on financial and moral questions of the society.
These activities need to be studied from the ethical point of view. It is a duty of the rehabilitation team to increase the general social activity for the benefit of the disabled. The public must understand that the injured people belong in the society and have the right to return to the places which they were forced to leave; and finding themselves in these places again they should be assured satisfactory conditions of living in spite of their limitations.
The annually increasing number of children and adults who must undergo rehabilitation leads to difficult situations and creates conflicts with the principle of distributive justice. Specialists in applied ethics should help to solve these problems or indicate a method of finding the right solutions. The need for the right solutions to these problems is urgent and perceived in common by physicians, lawyers, architects, and various other specialists who work toward the creation of a new rehabilitation model in Poland.