A proposed rural healthcare ethics agenda

Abstract

The unique context of the rural setting provides special challenges to furnishing ethical healthcare to its approximately 62 million inhabitants. Although rural communities are widely diverse, most have the following common features: limited economic resources, shared values, reduced health status, limited availability of and accessibility to healthcare services, overlapping professional–patient relationships and care giver stress. These rural features shape common healthcare ethical issues, including threats to confidentiality, boundary issues, professional–patient relationship and allocation of resources. To date, there exists a limited focus on rural healthcare ethics shown by the scarcity of rural healthcare ethics literature, rural ethics committees, rural focused ethics training and research on rural ethics issues. An interdisciplinary group of rural healthcare ethicists with backgrounds in medicine, nursing and philosophy was convened to explore the need for a rural healthcare ethics agenda. At the meeting, the Coalition for Rural Health Care Ethics agreed to a definition of rural healthcare ethics and a broad-ranging rural ethics agenda with the ultimate goal of enhancing the quality of patient care in rural America. The proposed agenda calls for increasing awareness and understanding of rural healthcare ethics through the development of evidence—informed, rural-attuned research, scholarship and education in collaboration with rural healthcare professionals, healthcare institutions and the diverse rural population.

Reflexões sobre questões morais na relação de indígenas com os serviços de saúde

“…A percepção, compreensão e resolução dos problemas morais nos serviços de saúde são fortemente influenciadas pelo contexto, rural ou urbano, onde ocorrem 1,2 . Uma característica fundamental dos serviços de saúde em contextos rurais é que frequentemente as populações atendidas possuem conhecimentos, práticas e valores diferentes dos reconhecidos pelos profissionais de saúde.…”

Professional Boundary Issues in Practice

“…8 Unlike in urban settings, there is less of a buffer in rural areas between the personal and the professional self. 9 Not only is the medical community smaller, but providers are also more apt to have mutual friends and shared activities. Most residents attend the same community centers, dances, and school functions.…”

Preventive Ethics and Rural Healthcare: Addressing Issues on a Systems Level

“…For example, dual and overlapping professional-patient relationships means that practicing medicine in a small rural setting generally is equivalent to living and working in the same community. Hence, professionals may be reluctant to record in a patient's medical chart a potentially stigmatizing diagnosis because it is common for a patient's relative or friend to be a member of the healthcare professional's staff, or even the billing clerk who records the diagnoses-it is very challenging to maintain confidentiality (Nelson et al 2007).…”

“…Given the dearth of these studies, an ambitious but much needed rural healthcare ethics agenda has been proposed (Nelson et al 2007). This agenda includes an increased awareness and understanding of ethical issues as perceived by rural residents and healthcare professionals, including the contextual influence on ethical issues and how the issues are different from nonrural settings; fostering a dialog with the general healthcare ethics community regarding the unique nature of rural ethical issues; collaboration with rural healthcare professionals to draft guidelines for dealing with common, recurring ethical conflicts; development and implementation of ethics training curricula and other educational resources for and with rural clinicians, administrators, and policy makers; and providing an ethics perspective to administrators and policy makers charged with allocating healthcare resources (Nelson et al 2007). How then might preventive ethics address quality gaps in healthcare delivery within the rural context?…”

“…Common rural healthcare ethical issues include confidentiality, boundary issues, and the overlapping professional-patient relationship; shared-decision making; the allocation of limited resources and access to quality care; cultural and personal values; truth telling; the patient's inability to pay for care; and referral to large, specialized and distant medical centers (Nelson et al 2006;Nelson et al 2007). For example, dual and overlapping professional-patient relationships means that practicing medicine in a small rural setting generally is equivalent to living and working in the same community.…”