Abstract
Study design
Mixed-method study (small group discussions and online literature search).
Objectives
Identify the ethical issues and dilemmas faced by rehabilitation professionals involved in the service delivery to the persons with spinal cord injury (SCI) in the low income and lower-middle-income countries (LIC/LMIC) located in Asia.
Setting
Small group discussions in three biomedical conferences in Dhaka, Bangladesh and Kualalampur, Malaysia.
Methods
Three small group discussions (30–45 min each) were held during three international conferences in 2019. The conferences brought together experts in the fields of neurology, rehabilitation, neurorehabilitation, and bioethics. A summary of SCI practice points and dilemmas were documented including goals of care, duties of rehabilitation professionals, health care worker-patient relationships, roles, and expectations of family members at different care settings.
Results
There is a paucity of literature on this topic. The application of the principles of contemporary bioethics in the pluralistic societies of LIC/LMIC can be challenging. The ethical dilemmas faced by rehabilitation professionals working in LIC/LMIC are diverse and different from those reported from the Western and developed countries. Ethical issues and dilemmas identified were understanding patient autonomy in decision making, lack of insurance for SCI rehabilitation, financial challenges, challenges of providing emerging technology in SCI rehabilitation and SCI rehabilitation during disasters.
Conclusions
We have summarized the possible ethical issues and dilemmas which rehabilitation professionals in LIC/LMIC may encounter during delivery of SCI rehabilitation services. We hope it generates a discussion on an often-neglected aspect of SCI care in the LIC/LMIC and helps identify the complexities of ethical dilemmas unique to persons with SCI living in a developing country.
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We gratefully acknowledge the experience sharing of all participants of the group discussion.
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TU gave the idea for the study. He was responsible for collecting responses from the participants and summarizing them for this manuscript. He carried out the revisions and gave approval for the final version of the article. MAS performed the initial literature search. He contributed to writing the first draft, extracting and analyzing data, interpreting results. He gave approval for the final version of the article. FAR performed the literature search, extracted data revised the first draft. He gave approval for the final version of the article. MS contributed to revising the first draft, extracting, and analyzing data, interpreting results, and gave approval for the final version of the article.
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Uddin, T., Shakoor, M.A., Rathore, F.A. et al. Ethical issues and dilemmas in spinal cord injury rehabilitation in the developing world: a mixed-method study. Spinal Cord 60, 882–887 (2022). https://doi.org/10.1038/s41393-022-00808-8
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DOI: https://doi.org/10.1038/s41393-022-00808-8
