Ethical implications of caring in rehabilitation.

The establishment of special caring relationships between spinal cord injured individuals (SCI) and nurses or therapists during rehabilitation creates unique ethical dilemmas. This paper will explore the practical and ethical implications for health care professionals who feel a moral imperative, compelled by their special relationship with a particular SCI individual, to "break the rules" within a rehabilitation bureaucracy in order to provide individualized health care. From the staff perspective two issues will be examined: the status of special relationships in a health care organization and the ability to maintain one's personal and professional standards in a managed care environment. From the administrative perspective two ethical issues will be explored: the challenge of pursuing the good of the patient and the organization while navigating between the public and private spheres of health care in a health care system that values standardization.