Rehabilitation Potential as a Social Judgement

Abstract 'Rehabilitation potential' is among the quieter categories of contemporary clinical practice. It appears in referral criteria, admission decisions and discharge planning as a technical estimate of how much function a patient might regain. This article argues that, applied to older people, it operates instead as a social judgement, and that the judgement long predates the vocabulary in which it is now expressed. Reading rehabilitation through the critical medical humanities, we trace practices directed at restoring function in later life from Greco-Roman antiquity, Ayurvedic Jara Chikitsa, Chinese tonification regimens and the Islamic bimaristan, through the medieval European almshouse and the Enlightenment hospital, to the geriatric units of the post-war welfare state. Across these settings the material provision of care varied enormously; the mechanism governing access did not. Societies restored older bodies to the extent that they judged those bodies worth restoring, and expressed that judgement in whichever idiom was locally authoritative, humoral, theological, actuarial and now diagnostic. We identify three properties that allow the judgement to pass as a measurement: it is comparative, it is prospective, and it is self-confirming, since withholding rehabilitation produces the deterioration that retrospectively justifies the refusal. Naming these properties has consequences for practice. It shows why better prognostic instruments cannot correct the category from within, and why access to later-life rehabilitation requires the rights-based footing now taking shape in international law.