Professional, Ethical, and Legal Issues
Ethics and law questions test application of principles-beneficence, nonmaleficence, autonomy, justice, fidelity-and standards to rehabilitation contexts. Master informed consent, including consent for assessment and treatment and the limits of consent when capacity is impaired. Understand capacity vs. competence: capacity is a clinical determination task-specific to a decision; competence is a legal status decided by courts. Know confidentiality and its limits (danger to self/others, abuse reporting, court orders), and how team-based documentation affects privacy. Boundary and multiple-role issues arise in small rehabilitation communities. Advocacy for patients with disabilities is an ethical role, balanced with institutional constraints. Test security and test use standards apply to assessment. Understand disability law basics: the ADA (reasonable accommodations, nondiscrimination), IDEA (special education), and vocational rehabilitation statutes-know the general purpose, not fine statutory detail. Traps: assuming a patient's refusal of treatment proves incapacity (it does not if the choice is informed and reasoned), breaching confidentiality to family without consent, and confusing clinical capacity judgments with legal competence rulings.
Worked example: A patient with a TBI refuses a recommended procedure; they can state reasons consistent with their values. This supports capacity for that decision despite the TBI-diagnosis alone does not determine capacity. Rule of thumb: when ethics and law appear to conflict, identify the specific duty, the specific legal standard, and consult supervision/ethics resources rather than acting unilaterally.