摘要:

Among the most difficult issues in bioethics is social justice in the allocation of limited resources among needy subpopulations. Resource allocation decisions involving persons with traumatic brain injury are perhaps the most difficult of all, due, in part, to the extraordinary resource needs of persons with brain injury and the inability of many such individuals to express their preferences and desires. This article considers eight values and factors that enter into decisions regarding resource allocation for persons with brain injury. These factors include views on (1) the quality and meaning of life, (2) the moral culpability of the brain-injured person for his or her condition, (3) the social contribution of a person with a brain injury, (4) the allocation of family and societal responsibilities, (5) the concept of justice, (6) the type of justice being sought in a given situation, (7) the nature of health care, and (8) the efficacy of specific medical and rehabilitative interventions. This article concludes by offering ideas about how some of the polarization on resource allocation issues can be averted.

ISSN:0885-9701    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The proper use of psychopharmacologic agents in the management of traumatic brain injury (TBI) is not clearly developed. Although the potential for significant amelioration of post-TBI deficits exists through pharmacologic interventions, major deficits persist regarding relative indications, efficacy, and side effects. Extensive reliance upon these agents, primarily for behavior control, is common despite clinical indications of marginal or unknown validity. Various clinical, administrative, and economic forces tend to accentuate the use of psychopharmacologic agents and create potential conflicts of interest for prescribing physicians. The single-case methodology is an appropriate approach to these difficult clinical exigencies. Legal precedent from traditional psychiatric experience suggests legal guidelines for use of these agents in management of TBI. Failure to adhere to these may expose clinicians to liability.

ISSN:0885-9701    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Patients with combined traumatic brain injury and human immunodeficiency virus infection should be expected to present for rehabilitation in increasing numbers. Behavioral, cognitive, family, and other problems may be exacerbated in such patients, resulting in greater challenges for medical management, rehabilitation, and disposition planning. Clinical and ethical implications for treatment, testing, and disposition are discussed.

ISSN:0885-9701    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

This article identifies, illustrates, and discusses certain ethical issues and dilemmas frequently encountered and presented by families of brain-injured persons. Among these are issues of surrogacy, goal setting, and the limits of familial obligations. Granting that no easy solutions to these difficult issues exist, the article encourages further professional consideration of a host of value-laden conflicts that can seriously compromise the already difficult task of caring for brain-injured persons.

ISSN:0885-9701    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A model for evaluating traumatically brain-injured adults' competency to consent to rehabilitative interventions is presented. Assessment foci are capacity to understand and reason. It is argued that judgments regarding competency should be based on best observed performance under optimal conditions in a rehabilitative context that promotes patient self-sufficiency. The proposed methodology provides a practical means of assessing competency in persons with traumatic brain injury (TBI) whose functional abilities can be quite variable, and of evaluating the effect of structuring patient-provider interactions so as to maximize the patient's capacity to understand and to reason.

ISSN:0885-9701    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

This article examines legal and ethical issues in the rehabilitation of the head-injured client, particularly the use of guardianship. Several models of rehabilitation goal setting are discussed, with a particular emphasis upon an educational model for the relationship between provider and client. Consistent with the educational model, questions are raised about the institution of legal guardianship given the dynamic changes that often occur in a head-injured client's competency during his or her rehabilitation course. The authors suggest changes in certain guardianship procedures that would interfere as little as possible with client growth and autonomy.

ISSN:0885-9701    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The fairly recent appearance of portable and user friendly videotape equipment has stimulated its use in rehabilitation settings, where its value as an educational, documentational, and clinical tool has been recognized for some time. Nevertheless, photographing, filming, or videotaping someone in the process of receiving medical care raises an array of legal and ethical considerations, especially focusing on the patient's right of privacy. This article discusses such considerations and provides suggestions so that rehabilitation professionals might better appreciate their duties to patients when videotaping is contemplated.

ISSN:0885-9701    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Alcohol and head injury are closely linked. Of 102 patients admitted to the hospital through a trauma center for medical treatment, at least 56% had a documentable blood alcohol level (BAL). These patients were studied through a retrospective review of their records and compared to patients with no BAL at the time of admission. Findings suggest that if a BAL is present and, furthermore, if the individual's BAL Is at the intoxicated level (.10), a stormier medical course is predicted. Specific findings included longer length of stay, longer duration of agitation, and lower cognitive status at discharge. The etiology and implications of these findings are discussed, and recommendations are made. It is concluded that a head-injured individual who is admitted to the hospital with a BAL will be more difficult to manage, will have slower acute recovery, will thus cost more to treat, and may return to drinking. Better identification and an improvement in resources for these patients are recommended.

ISSN:0885-9701    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1989

数据来源: OVID