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Biomedical subjects

J D Banja

Publications and source records attributed to J D Banja.

16 recordsLinked to original sources
PubMed2000

The rehabilitation marketplace: economics, values, and proposals for reform.

This article examines whether the ideals, goals, and values of medical rehabilitation can be realized in a market-based health care system. The article observes that rehabilitation is greatly disadvantaged in today's health care marketplace, which violates virtually all the assumptions of a perfectly competitive one. Nevertheless, the authors argue that rehabilitation goals and market economics are not inherently incompatible and call for several market reforms that are congruent with both rehabilitation goals and market theory. These reforms will clarify and facilitate providers' fiduciary responsibilities to patients as well as their accountability to payers. The authors conclude that while the marketplace is an inevitable medium for realizing rehabilitation goals, the vision and value of rehabilitation will not derive from the internal workings of the marketplace but ultimately from committed individuals and socially responsible institutions outside the marketplace.

Health Care Reform↗
PubMed1996

Ethics, values, and world culture: the impact on rehabilitation.

Cultural beliefs affect how health-care professionals and consumers interpret health, illness and disability. This discussion focuses on the therapeutic relevance of cultural beliefs; the implications of cultural practices and cultural values for rehabilitation theory; and the implications of cultural beliefs for social justice. Cultural beliefs cause people to learn 'approved' ways of being ill, influence their attribution of the aetiology of illness or disability, and determine what they expect from treatment and their physicians. Medical professionals need to be aware of cultural differences that can affect the outcome of treatment. Rehabilitation can also be culturally diverse. A universal, transcultural understanding of rehabilitation is possible, however, if it is understood that disabilities are concerned with integrated activities expected of the person or the body as a whole. If culture distinguishes how we engage the world, rehabilitation universally addresses the form of that engagement in its physical, behavioural, and/or cognitive manifestations.

Attitude to Health↗
PubMed1994

Deception in advertising and marketing: ethical applications in rehabilitation.

A much discussed issue in contemporary discussions of health care reform is the considerable competition that is anticipated to occur among providers. An inevitable aspect of this competition will be the ways health care services are presented in the marketplace through advertising and other forms of promotional literature. Considerable concern has already emerged among certain rehabilitation professionals, however, that advertising and marketing practices in rehabilitation must cohere with ethical standards. This article will discuss certain aspects of those standards, particularly as they have evolved from the Federal Trade Commission's definition of and rulings on deceptive practices in advertising. Salient aspects of the Commission's 1983 definition of deception will be related to rehabilitation by way of examining instances of rehabilitation advertising and marketing that might satisfy the Commission's definition of deception. The article will conclude with certain recommendations, principally drawn from various Federal Trade Commission rulings, that might be useful to individuals or corporate entities who advertise or market rehabilitation services.

Advertising↗
PubMed1993

Discussing cardiopulmonary resuscitation with elderly rehabilitation patients. Ethical and clinical considerations toward the formation of policy.

Studies have demonstrated that most elderly persons who undergo cardiopulmonary resuscitation do not survive to hospital discharge. Because resuscitation efforts among elderly patients may fail either to restore hemodynamic stability or the patient's prearrest functional levels, ethical arguments as well as regulatory standards have urged the involvement of patients and their families in deciding about the advisedness of cardiopulmonary resuscitation. This article examines various ethical dimensions of conducting do-not-resuscitate discussions with competent, elderly persons in acute rehabilitation environments. Viewpoints that seek to excuse or resist do not resuscitate discussions among elderly rehabilitation consumers will be discussed as well as programmatic or psychological factors that appear to bolster such positions. These arguments, however, will be shown to be inferior to others that urge rehabilitation providers to engage their patients in frank and sincere discussions regarding their resuscitation status in the event of arrest.

Aged↗
PubMed1992

Outcomes following cardiopulmonary resuscitation in an acute rehabilitation hospital. Clinical and ethical implications.

This retrospective study examines cases of cardiac arrest requiring cardiopulmonary resuscitation (CPR) in an acute rehabilitation hospital. All admissions to the Center for Rehabilitation Medicine at Emory University, a 56-bed facility, are reviewed. Seventeen cases of true cardiac arrest are identified for analysis of ultimate disposition over a 10-yr period. Only one patient (5.9%) survived CPR to discharge from the rehabilitation hospital, but he died subsequent to his transfer to the acute hospital. Though the sample size is small, it reflects the total population of patients eligible for CPR who suffered a cardiac arrest. We conclude that CPR is generally not successful in the elderly inpatient rehabilitation population. The growing clinical complexity of the rehabilitation patient demands that health-care providers and their patients more regularly address decision-making issues pertinent to CPR.

Age Factors↗
PubMed1987

Malpractice litigation for uninformed consent. Implications for physical therapists.

Although physicians generally are expected to secure their patients' informed consent to medical treatment, an emerging body of legal opinion holds that in certain situations nurses and allied health care professionals may be found similarly responsible. Failure of a health care provider to protect a patient's right of informed consent might result in a lawsuit alleging that serious harm was sustained needlessly because the patient plaintiff was not informed of certain significant risks of or consequences that resulted from treatment. As a professional group that puts patients at risk of harm during treatment, physical therapists need to know about their legal duty to facilitate a patient's awareness of and consent to treatment. This article discusses the nature of that duty and how a patient plaintiff might try to prove negligence against a physical therapist who allegedly fails to secure a valid statement of informed consent. The article also provides recommendations so that physical therapists might protect themselves from malpractice suits alleging "uninformed" consent.

Humans↗
PubMed1986

Proxy consent to medical treatment: implications for rehabilitation.

When a patient is unable to give an informed consent to a proposed therapeutic intervention, the principal health care provider is legally bound to secure a consent to treatment from the patient's legally authorized guardian or proxy. The appointment of a proxy decision-maker is a legal rather than a medical process, and health care providers risk a law suit if it is circumvented. Furthermore, the nature of the proxy appointment, which varies from state to state, is complicated by an absence of well-defined guidelines relating to the conditions under which a proxy is needed, who may serve as a proxy, how the proxy should be selected, and the scope of the proxy's authority. Because rehabilitation serves many incompetent patients, its providers should be intimately acquainted with the laws on appointing proxies so as to protect patient rights and to avoid personal liability.

Ethics, Medical↗
PubMed1985

Whistleblowing in physical therapy.

Because of their central role in rehabilitation medicine, physical therapists often are cognizant of possible wrongdoing that persists in their facilities. Often, they may be perplexed whether or how to effect a remedy. This article presents issues for physical therapists to consider in identifying and alleging instances of misconduct within organizational settings. Specific suggestions are provided for approaches to remediating wrongful and dangerous situations when customary organizational channels are ineffectual. This article also examines the various kinds of organizational hostilities that may be inflicted on employees who publicly speak out against wrongdoing and the type of legal protection afforded to whistleblowers.

Ethics, Professional↗
PubMedDate not supplied

The improbable future of employment-based insurance.

Voluntary, employment-based insurance is afflicted by a variety of internal imbalances: inequities in the way health insurance is paid for, a conflict of interest in the selection of health insurance, the concentration of the healthy and the sick into separate plans, and free-ridership. But while all these imbalances generate severe problems, those seeking to reform health insurance in the United States should concentrate on the last two.

Government Regulation↗