Values and Outcomes: The Ethical Implications of Multiple Meanings

Abstract

Because outcomes can be regarded as indices of quality and, therefore, tokens of professional accountability, they raise ethical issues about the merits of a projected course of rehabilitative treatment and—given the “outcome”—whether or not such treatment is “worthwhile.” At their deepest level, outcomes provide an opportunity for all significant parties to the rehabilitation enterprise (i.e., patients, providers, families, employers, payers, and the body politic) to inject their values into interpreting the meaning or worth of outcomes. By understanding valuing as the process of ascribing worth or significance, this article will show how outcome determinations predictably and inevitably trigger value-laden beliefs, objectives, and conflicts that, in turn, can have significant impact on the rehabilitation process. This article will end by considering certain notions whereby such valuative heterogeneity and clashes might be negotiated so that the identity of rehabilitation is not compromised.