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ASL of the Province of Varese, Italy
Specialists in rehabilitation have shown growing interest in ethical issues. This paper is my contribution to the debate. Problems related to the evaluations and outcomes of rehabilitation have received much attention in the scientific literature. In parallel, numerous articles have expressed the sense of unease and need for ethical lines of conduct when facing hard medical choices, exacerbated by evident financial restrictions. A thorough review of the literature yielded a selection of ethical considerations that are widely accepted by well-reputed authors. These are presented along with my own comments on some of the most recurrent issues: - reconciling scientific validity with patients’ informed consent; -judging the capacity to evaluate the results of treatments; - reconciling the State’s need to limit spending on health-care with patients’ right to proper care (with particular reference to disabled patients); - setting criteria for the selection and inclusion of patients in rehabilitation programmes, including patients with chronic diseases; safeguarding personal autonomy, even in cases of severe disability. Some of these concepts are illustrated by examples aiming to demonstrate the importance of ensuring that rehabilitation specialists receive a thorough grounding in ethics if they are to act as competent professionals. It is hoped that the article will stimulate a fruitful exchange of opinions on the considerations expressed and on the vast field of applications of ethics in rehabilitation.