Hunt Matthew, Clarke Stephen, Lencucha Raphael
School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
Center for Interdisciplinary Research in Rehabilitation, Montreal, Canada.
Disabil Rehabil. 2021 Mar;43(6):870-876. doi: 10.1080/09638288.2019.1637950. Epub 2019 Jul 31.
Patients receiving rehabilitation care may act in ways that pose risks to the wellbeing of others. There are numerous situations when patients' actions might pose risks to others, including family members, other patients, or society. For example, such risks arise if patients wish to return home to living in an apartment but risk starting a fire while cooking, or if they insist on driving but their health condition makes doing so unsafe. These situations give rise to ethical challenges, including for health professionals as they seek to promote their patient's autonomy while minimizing risks for the patient and others.
We develop a conceptual analysis examining how relational ethics can inform understanding of rehabilitation professionals' responsibilities in responding to third-party risk.
Relational ethics foregrounds the situated, dynamic, and interdependent nature of relationships between people, and supports dialogic approaches to clarify how best to respond. We present a set of 10 questions linked to the concepts of relational autonomy and relational social justice that can contribute to ethical reflection and deliberation among providers, patients, families, and others involved.
Relational ethics provides a distinctive angle of view on challenging issues of third-party risk in rehabilitation care.Implications for rehabilitationManaging risk is a recurrent source of ethical challenge in rehabilitation care.Risks to third parties give rise to significant ethical tensions.We propose ten questions that can support a relational ethics approach for responding to situations of third-party risk.
接受康复护理的患者可能会以对他人福祉构成风险的方式行事。在许多情况下，患者的行为可能会对他人（包括家庭成员、其他患者或社会）构成风险。例如，如果患者希望回家住在公寓里，但做饭时有引发火灾的风险，或者如果他们坚持开车但健康状况使这样做不安全，就会出现此类风险。这些情况引发了伦理挑战，包括对健康专业人员而言，他们在努力促进患者自主权的同时，要尽量降低患者及他人面临的风险。
我们进行了一项概念分析，考察关系伦理如何有助于理解康复专业人员在应对第三方风险时的责任。
关系伦理突出了人与人之间关系的情境性、动态性和相互依存性，并支持采用对话方式来阐明如何做出最佳应对。我们提出了一组与关系自主性和关系社会正义概念相关的10个问题，这些问题有助于提供者、患者、家庭及其他相关人员进行伦理反思和审议。
关系伦理为康复护理中第三方风险这一具有挑战性的问题提供了独特视角。对康复的启示在康复护理中，管理风险是伦理挑战的一个反复出现的源头。对第三方的风险会引发重大的伦理紧张关系。我们提出了10个问题，这些问题可以支持采用关系伦理方法来应对第三方风险情况。
