Ethical issues and dilemmas in spinal cord injury rehabilitation in the developing world: a mixed-method study

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.

Automated summary

This study aims to identify the ethical issues and dilemmas faced by rehabilitation professionals in low and lower-middle-income countries (LMICs) when delivering services to individuals with spinal cord injury (SCI). By conducting small group discussions and an online literature search, the study found that the ethical dilemmas encountered by rehabilitation professionals in LMICs are different from those reported in Western and developed countries.