Communication Affichée:

Le 01/02/2023 de 03:01 à 03:01

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Questions d'ordre éthique dans la pratique de la médecine physique et de réadaptation

SANA SALAH (Monastir, Tunisie), Anis Jellad (Monastir, Tunisie), Zohra Ben Salah (Monastir, Tunisie)

Objective : To identify the situations that raise ethical problems in the practice of Physical Medicine and Rehabilitation (PMR) in Tunisia.

Material / Patients and Methods : A self-administered questionnaire was sent to young PMR practitioners.  It included multiple-choice questions and free-response questions covering the following items: autonomy, Beneficence and Justice. The survey was conducted over a six-month period (January-June 2019).

Results : Four major ethical issues types were found:
Health care reimbursement issues: related to the lack of insurance benefits for needed services. Clinicians are troubled by legal matters and potential harms arising as a result of reimbursement decisions.  Patients needing rehabilitative care can be admitted only in four public Departments all over the country. Their recruitment is often limited to some etiologies, mainly neurologic and traumatic injuries in young patients.
Setting rehabilitation goals represents an ethical challenge. Specifically rehabilitation professionals have to balance their knowledge and experience with the wishes (sometimes unrealistic) of patients and families
Decision-making capacity of the patient is found not only in the context of informed consent but also in the context of refusal of team recommendations.
Confidentiality  issues: Concerns were related to handling delicate or highly personal information in the context of the treatment team with families, and with third-party payers.

Discussion - Conclusion : Ethical issues within the rehabilitation setting seem to be different from those in the acute care setting. Different methods can help Rehabilitation professionals dealing with ethical issues. Dialogue and policies fueled by public debates are crucial to find out reasonable solutions that would be acceptable for all the stakeholders.

Keywords : disability - public health resources - social policy - ethics