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Informed consent and provider-patient relationships in rehabilitation medicine.

The legitimacy of paternalism in health care relationships has been severely criticized by those in the field of medical ethics. Critics have argued that paternalism has no place in physician/patient encounters. Patients must always be treated as autonomous agents, capable of directing the course of their medical care. Informed consent has come to represent the mechanism through which autonomy can best be assured in medical relationships. If provider/patient interactions are viewed as a contract between consenting agents, then providers are obligated to obtain informed consent for all interventions they wish to undertake. This view, however, relies upon examples of care provided to those with acute medical problems. In rehabilitation, it can be argued that for some patients at some times during their care, a contractual model would be inappropriate. Especially when patients have undergone a sudden and unexpected course of severe impairment, it is difficult to conceptualize provider/patient relationships in the context of a contract. Providers are more accurately seen as acting in educational roles toward those in their care. If this is so, then there may be instances in which paternalistic behavior toward rehabilitation patients is ethically justified. Informed consent must be carefully examined if it is to be a useful doctrine in the context of rehabilitative care.