Outcomes evaluation in TBI rehabilitation. Part III: Ethical perspectives and social policy.

The choice and interpretation of rehabilitation outcomes are suffused with personal and social values. In this article we examine the ethical implications of outcomes evaluation. The viewpoints of key parties to the rehabilitation process are considered. Self-determination of persons served is of central significance. Valuative conflicts in practice frequently obscure the meaning of a "good" outcome. Outcome studies can contribute to the development of a just policy but bear serious ethical responsibilities. Although these issues are general to rehabilitation, persons with TBI are at special risk of being disenfranchised. A new paradigm or clinical philosophy is needed to respond to the new and divergent pressures facing clinical rehabilitation.