Abstract

This study features narrative accounts of ethical dilemmas encountered in the practice of physical therapy. These descriptive stories enhance our understanding of how ethical issues are conceptualized within the context of rehabilitation. The ethical dimensions of rehabilitation are embedded in the constraints and realities of clinical practice and suggest considerations for ethical analysis that differ from the predominant paradigm of medical ethics. The bioethical theories of casuistry and care are particularly sensitive to the contextual features of clinical care, as such, they form the theoretical framework for this research. ;Twelve physical therapists practicing in rehabilitation centers were interviewed about an ethical dilemma they encountered in clinical practice. Grounded theory methodology was used to code the data and identify the central themes that emerged from their narrative accounts. These themes reveal therapists' ethical concerns related to managing treatment and terminating treatment . ;These themes provide a fresh perspective for understanding the moral ecology of rehabilitation and reinforce many suggestions by authors of previous studies that rehabilitation occurs in a different social context from that of acute medicine. The exact differences have not been completely examined; however, the results reveal that there are social inequalities inherent in negotiating clinical decisions which add to the complexity of ethical decision-making. Professional expertise creates imbalances of power that at times interfere with the ideal of shared decision-making, can diminish the patient's motivation and compromise the patient's best interests. The author proposes an empowerment model for informed consent that attends to these inequalities of power and authority. Further, the empirical findings in this study demonstrate that the general features of the casuistry model are useful for uncovering the salient ethical features of rehabilitation cases