Ethics in Rehabilitation Medicine

Known as the quality-of-life specialty, physical medicine and rehabilitation aims to improve movement and reduce psychological, emotional, family, and vocational stresses that often accompany temporary or permanent loss of motor function. Congenital and acquired conditions—from spina bifida to traumatic injury to Parkinson’s disease—fall within physiatrists’ purview. Contributors to the May issue of the AMA Journal of Ethics tackle the serious ethical questions physiatrists confront as they offer patients encouragement tempered by realistic expectations, arrange safe discharge and follow-up, manage long-term pain, and fight for access to the best rehab care for all who need it.

Volume 17, Number 6: 489-596 Full Issue PDF
  • From the Editor
    Jun 2015

    The Motor Function Specialty

    Gaurav Jay Dhiman
    The ethics of treating patients with a variety of physical impairments and disabilities is as complex as the clinical challenges.
    AMA J Ethics. 2015;17(6):496-499. doi: 10.1001/journalofethics.2015.17.6.fred1-1506.
  • Case and Commentary
    Jun 2015

    Athlete Return-to-Play Decisions in Sports Medicine

    Adam S. Tenforde, MD and Michael Fredericson, MD
    In treating sports injuries in athletes who may wish to return to play before fully recovering, physicians can simultaneously uphold the principles of respect for autonomy and beneficence by developing a return-to-play plan, which allows patients to take responsibility for meeting goals at each stage of their recovery.
    AMA J Ethics. 2015;17(6):511-514. doi: 10.1001/journalofethics.2015.17.6.ecas3-1506.
  • Medical Education
    Jun 2015

    Assessing Competency in Physical Medicine and Rehabilitation Residency: the ACGME Milestones Initiative

    Julian Willoughby, MD, MPH, Vu Nguyen, MD, MBA, and William L. Bockenek, MD
    The ACGME milestones initiative promises to improve the process of assessing medical resident competency by providing, throughout the course of residency training, systematic, comprehensive, and specialty-specific evaluation of the Accreditation Council for Graduate Education’s six clinical competencies.
    AMA J Ethics. 2015;17(6):515-520. doi: 10.1001/journalofethics.2015.17.6.medu1-1506.
  • In the Literature
    Jun 2015

    A Clinical Ethics Approach to Opioid Treatment of Chronic Noncancer Pain

    Mitchell J. Cohen, MD and William C. Jangro, DO
    Because knowledge about the efficacy of long-term opioid use is lacking, decisions about opioid treatment for chronic nonmalignant pain should be guided by a six-step decision making process that is based in clinical ethics.
    AMA J Ethics. 2015;17(6):521-529. doi: 10.1001/journalofethics.2015.17.6.nlit1-1506.
  • Health Law
    Jun 2015

    Service Dogs for Veterans with Posttraumatic Stress Disorder

    Richard Weinmeyer, JD, MA, MPhil
    Efforts are underway to make posttraumatic stress disorder a condition for which the Veterans Administration will authorize coverage for use of service dogs.
    AMA J Ethics. 2015;17(6):547-552. doi: 10.1001/journalofethics.2015.17.6.hlaw1-1506.
  • State of the Art and Science
    Jun 2015

    Ethics in Rehabilitation: Access to Prosthetics and Quality Care Following Amputation

    Colonel Paul F. Pasquina, USA (Ret), MD, Antonio J. Carvalho, and Terrence Patrick Sheehan, MD
    Health outcomes for people who have had amputations are affected not only by barriers to access, such as race, socioeconomic status and cost, but also by the type of facility where they receive treatment and rehabilitative services.
    AMA J Ethics. 2015;17(6):535-546. doi: 10.1001/journalofethics.2015.17.6.stas1-1506
  • Policy Forum
    Jun 2015

    Access to Rehabilitative Care in the Affordable Care Act Era

    Steven G. Ullmann, PhD
    The ACA does not, as intended, provide equal access to health care, due to financial and geographic barriers, and low coverage limits access to habilitative and rehabilitative services.
    AMA J Ethics. 2015;17(6):553-557. doi: 10.1001/journalofethics.2015.17.6.pfor1-1506.
  • Medicine and Society
    Jun 2015

    The Disability Movement’s Critique of Rehabilitation’s Medical Model: A Rebuttal

    John D. Banja, PhD
    Some disability advocates take issue with the “normalization” goals of the medical model of rehabilitation, but expressions of that position can be dismissive of rehabilitationists’ efforts to remediate oppressive functional deficits.
    AMA J Ethics. 2015;17(6):562-567. doi: 10.1001/journalofethics.2015.17.6.msoc1-1506.
  • History of Medicine
    Jun 2015

    History of Physical Medicine and Rehabilitation and Its Ethical Dimensions

    Levan Atanelov, MD, MS, Steven A. Stiens, MD, MS, and Mark A. Young, MD, MBA
    Physical medicine and rehabilitation has developed into a medical specialty that aims to restore optimal patient function in multiple dimensions of life with an interdisciplinary approach to care delivery.
    AMA J Ethics. 2015;17(6):568-574. doi: 10.1001/journalofethics.2015.17.6.mhst1-1506.
  • Art of Medicine
    Jun 2015

    Multifaceted Nexus

    Kyle T. Amber, MD
    Artwork by Kyle T. Amber.
    AMA J Ethics. 2015;17(6):575-. doi: 10.1001/journalofethics.2015.17.6.imhl1-1506.
  • Viewpoint
    Jun 2015

    Reuniting Through the Medical Humanities: Two Educators, Two Programs

    Martin Kohn, PhD and Eric Kodish, MD
    The five-year curriculum in medical humanities at the Cleveland Clinic Lerner College of Medicine seeks to create a foundation for practice and to develop intercampus, interinstitutional, and community programming.
    AMA J Ethics. 2015;17(6):491-495. doi: 10.1001/journalofethics.2015.17.6.spec1-1506.
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    Podcast
    Jun 2015

    Ethics Talk: Ethics in Research with People Who Have Disabilities

    This month, AMA Journal of Ethics' theme editor, Gaurav Jay Dhiman, a third-year medical student at the University of Miami Leonard M. Miller School of Medicine, interviewed Jonathan D. Moreno, PhD, on the role of bioethicists in military research and ethical issues in research on people with disabilities.