Health care providers are not generally trained in moral philosophy, and yet they often have to make serious and difficult ethical decisions about patient care. In some cases, the health care provider may have assistance from a bioethicist but may feel the advice is not quite right and yet not know how to clearly and forcefully articulate a better position or pinpoint what seems wrong. In other cases, the provider may have a feeling of frustration that he or she is not doing enough for a patient but is not sure what more can be done, such as when a patient is being released from medical care into an environment that is inadequate to his or her needs, or when a patient is being informed about a procedure to obtain consent but may not really understand the possible ramifications of the risks involved, or when a patient is being involved as an equal partner in decisions about the treatment options but may be making a mistaken decision. This issue of Topics in Spinal Cord Rehabilitation addresses some specific ethical dilemmas and provides a general understanding of ethics or moral philosophy that exceeds what is learned from parents, school, or religion, which normally involves basic decency and courtesy to others or being obedient to (often oversimplified or unjustified) rules. In some cases, health care providers must help establish policies, not just follow them; obedience, even when it is a virtue, is not a guide for deciding which policies are best.

Garlikov R. Reasoning. Available at: www.akat.com/reasoning.htm
Kuhn T. The Structure of Scientific Revolutions. Chicago: University of Chicago Press; 1962.
The Structure of Scientific Revolutions
Garlikov R. The nature of the logic of confirmation in science. Available at: www.garlikov.com/Science.html
Garlikov R. Entropy, scientific explanations, pseudo-scientific explanations, and teaching science. Available at: www.garlikov.com/science/sciteach.htm
Garlikov R. Shedding light on time: learning and teaching difficult concepts. Available at: www.garlikov.com/teaching/time
Garlikov R. Math, science, knowledge, and nature. Available at: www.garlikov.com/philosophy/physmath.htm
Kraft MR. Refusal of treatment: an ethical dilemma. SCI Nurs. 1999;16(1):9–13, 20.
Refusal of treatment: an ethical dilemma
SCI Nurs.
, vol. 
16
 (pg. 
9
-
13
)
Maynard FM, Muth AS. The choice to end life as a ventilator-dependent quadriplegic. Arch Phys Med Rehabil. 1987;68:862–864.
The choice to end life as a ventilator-dependent quadriplegic
Arch Phys Med Rehabil
, vol. 
68
 (pg. 
862
-
864
)
Gerhart KA, Corbet B. Uninformed consent; biased decisionmaking following spinal cord injury. HEC Forum. 1995;7(2-3):110–121.
Uninformed consent; biased decisionmaking following spinal cord injury
HEC Forum
, vol. 
7
 (pg. 
110
-
121
)
Ohry A. Ethical questions in the treatment of spinal cord injured patients. Paraplegia. 1987;25:293–295.
Ethical questions in the treatment of spinal cord injured patients
Paraplegia
, vol. 
25
 (pg. 
293
-
295
)
Peters A. When the cheering stops. Disability Rag. 1985; March–April:5–9. Cited by Gerhart KA, Corbet B. Uninformed consent; biased decisionmaking following spinal cord injury. HEC Forum. 1995;7(2-3):110–121.
Disability Rag. 1985; March–April:5–9. Cited by Gerhart KA, Corbet B. Uninformed consent; biased decisionmaking following spinal cord injury
HEC Forum
, vol. 
7
 (pg. 
110
-
121
)
The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. Washington, DC: Office of the Secretary, Department of Health, Education, and Welfare; April 18, 1979.
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