Vol. 25:1 Spring 2009
Ethical Practice in Brain Injury Rehabilitation
Joanna Collicutt McGrath. Oxford: Oxford University Press, 2007.
I S B N 978 - 019 8 5 6 8 9 9 5; 19 2 PAG ES , PA PER $ 4 9. 9 5
As a neurologist and ethicist who helps patients and families make decisions about treatment options,
some of which carry grave risks, I am often told by patients that they are not afraid of dying. Dying,
however, is much less complex than living for years with severe physical or neurological disabilities.
Much has been written about the beginning and end of life—witness the ongoing stem cell, euthanasia,
and abortion wars. Less has been written about the difficult and painful decisions faced by acquired
brain injury (ABI) patients and their families. McGrath provides us with a concise, readable overview
of issues such persons face, and then outlines a hands-on, interactive process to help all parties arrive
at workable solutions.
Professor McGrath brings both her training as a neuropsychologist and Anglican priest along with
a giftedness in communication to this discourse; I read through the pages with an eagerness usually
associated with a good novel. Despite my background, I found a number of useful pearls and valuable
insights into care of patients with ABI and their families.
After a brief introduction, she provides an overview of the types and extent of disabilities patients with
ABI face. She then reviews the profound effect ABI has on self-image and perceived image by society.
Next, she explores the moral and ethical underpinnings of ethical decision-making. In Chapter Five, she
describes her vision of a good rehabilitation practice, and next explains ‘A heuristic for managing ethical
dilemmas’ (112), illustrating the process her center employs in decision-making.
McGrath concludes with eighteen complex but reali