Clarke Stephen, Barudin Jessica, Hunt Matthew
Biomedical Ethics Unit and Department of Philosophy, McGill University.
Cedar and Gold, Montreal.
Physiother Can. 2016;68(2):197-205. doi: 10.3138/ptc.2015-35GH.
This article reviews the literature regarding ethics and community-based rehabilitation (CBR) with the goal of identifying and analyzing ethical considerations associated with this approach. We conducted a critical interpretive review of the academic literature related to CBR in low- and middle-income countries and to indigenous communities in high-income countries. Using an inductive analysis of the collected articles, we identified five key topic areas related to ethical considerations. We then critically appraised this literature and developed eight questions that reflect areas of ethical tension, uncertainty, or debate. The five key topic areas are partnerships among stakeholders, respect for culture and local experience, empowerment, accountability, and fairness in programme design. The eight ethical questions are linked to these topics and associated with how CBR practices reflect commitments to equity, respect, inclusion, participation, and social justice. Continued engagement with ethical considerations associated with CBR can help to strengthen the foundations of this important and influential approach. It is crucial that all those involved in CBR projects, including physiotherapists, pay careful attention to the development of partnerships that, despite asymmetries among stakeholders, are respectful and effective.
本文回顾了有关伦理与社区康复(CBR)的文献,目的是识别和分析与这种方法相关的伦理考量。我们对低收入和中等收入国家与社区康复相关的学术文献以及高收入国家的原住民社区进行了批判性解释性综述。通过对收集到的文章进行归纳分析,我们确定了与伦理考量相关的五个关键主题领域。然后,我们对这些文献进行了批判性评估,并提出了八个反映伦理紧张、不确定性或争议领域的问题。这五个关键主题领域是利益相关者之间的伙伴关系、对文化和当地经验的尊重、赋权、问责制以及项目设计中的公平性。这八个伦理问题与这些主题相关,并涉及社区康复实践如何体现对公平、尊重、包容、参与和社会正义的承诺。持续关注与社区康复相关的伦理考量有助于加强这一重要且有影响力的方法的基础。至关重要的是,所有参与社区康复项目的人员,包括物理治疗师,都要密切关注伙伴关系的发展,尽管利益相关者之间存在不对称,但这些伙伴关系应是相互尊重且有效的。