Contracting Compliance: A Discussion of the Ethical Implications of Behavioural Contracts in the Rehabilitation Setting

Jane Cooper,Ann Heesters,Andria Bianchi,Kevin Rodrigues,Nathalie Brown

doi:10.7202/1065693ar

Abstract

The pervasive use of contracts in healthcare is a source of unease for many healthcare ethicists and patient advocates. This commentary examines the use of such contracts with individuals in rehabilitation settings who have complex medical and behavioural issues. The goals of this paper are to examine the many factors that can lead to contract use, to discuss some legal and ethical implications of contract use, and to assess contract use in light of concerns about health equity. The paper concludes with some practical alternatives to the use of such contracts, and refers specifically to tools that might be borrowed from the field of behavioural therapy.

Highlights

The term “patient contract,” for the purposes of this paper, refers to a written document developed by clinical teams and/or healthcare administrators, with the goal of encouraging patients to modify behaviours
Their legal standing is disputed, patient contracts are familiar to healthcare audiences in many contexts since they are employed for a myriad of purposes including suicide prevention, medication management, and behaviour modification [1]
We suggest that the widespread use of patient contracts ought to be re-evaluated on practical and ethical grounds

Summary

Introduction

The term “patient contract,” for the purposes of this paper, refers to a written document developed by clinical teams and/or healthcare administrators, with the goal of encouraging patients to modify behaviours. A patient contract generally contains a list of expectations that the patient must adhere to in order to retain access to services, while some may be employed to encourage patients to adopt a healthier lifestyle [1]. Their legal standing is disputed (even though they are often signed by patients and providers), patient contracts are familiar to healthcare audiences in many contexts since they are employed for a myriad of purposes including suicide prevention, medication management, and behaviour modification [1]. Our goal is to provide guidance to clinicians working in rehabilitation settings, we anticipate that our suggestions will be transferable to other contexts

Objectives

Conclusion