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

Vernillo, Anthony T.

doi:10.1080/15265160802147116

Cited by 8 publications

(5 citation statements)

References 7 publications

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“…This is essential in rural areas where policies are often generated from those residing in urban areas. Further, what this study illustrates is the need for a systems level approach to ethics, what Vernillo [35] has referred to as preventive ethics. The goal of preventive ethics is to "improve healthcare quality by identifying, prioritizing and addressing healthcare ethics at a system level" (p. 61).…”

Section: Discussionmentioning

confidence: 91%

Be known, be available, be mutual: a qualitative ethical analysis of social values in rural palliative care

2011

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BackgroundAlthough attention to healthcare ethics in rural areas has increased, specific focus on rural palliative care is still largely under-studied and under-theorized. The purpose of this study was to gain a deeper understanding of the values informing good palliative care from rural individuals' perspectives.MethodsWe conducted a qualitative ethnographic study in four rural communities in Western Canada. Each community had a population of 10, 000 or less and was located at least a three hour travelling distance by car from a specialist palliative care treatment centre. Data were collected over a 2-year period and included 95 interviews, 51 days of field work and 74 hours of direct participant observation where the researchers accompanied rural healthcare providers. Data were analyzed inductively to identify the most prevalent thematic values, and then coded using NVivo.ResultsThis study illuminated the core values of knowing and being known, being present and available, and community and mutuality that provide the foundation for ethically good rural palliative care. These values were congruent across the study communities and across the stakeholders involved in rural palliative care. Although these were highly prized values, each came with a corresponding ethical tension. Being known often resulted in a loss of privacy. Being available and present created a high degree of expectation and potential caregiver strain. The values of community and mutuality created entitlement issues, presenting daunting challenges for coordinated change.ConclusionsThe values identified in this study offer the opportunity to better understand common ethical tensions that arise in rural healthcare and key differences between rural and urban palliative care. In particular, these values shed light on problematic health system and health policy changes. When initiatives violate deeply held values and hard won rural capacity to address the needs of their dying members is undermined, there are long lasting negative consequences. The social fabric of rural life is frayed. These findings offer one way to re-conceptualize healthcare decision making through consideration of critical values to support ethically good palliative care in rural settings.

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Section: Discussionmentioning

confidence: 91%

Be known, be available, be mutual: a qualitative ethical analysis of social values in rural palliative care

2011

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“…Cook and Hoas (2008) describe the work of a pharmacist in a rural area who would correct a physician's prescriptions. Vernillo (2008) sums up the ethical problem described by Cook and Hoas (2008):…”

Section: Potato Ethics In Negotiation With Naive Urban Assumptionsmentioning

confidence: 99%

“…A pharmacist cannot legally change a physician’s prescription without permission from the physician. However, the physician tends to “slam the phone in your ear” when his orders are questioned or need clarification (Vernillo 2008 , 62).…”

Section: Potato Ethicsmentioning

confidence: 99%

Potato Ethics: What Rural Communities Can Teach Us about Healthcare

Fors

2023

Bioethical Inquiry

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In this paper I offer the term “potato ethics” to describe a particular professional rural health sensibility. I contrast this attitude with the sensibility behind urban professional ethics, which often focus on the narrow doctor–patient treatment relationship. The phrase appropriates a Swedish metaphor, the image of the potato as a humble side dish: plain, useful, versatile, and compatible with any main course. Potato ethics involves making oneself useful, being pragmatic, choosing to be like an invisible elf who prevents discontinuity rather than a more visible observer of formal rules and assigned tasks. It also includes actively taking part in everyday disaster-prevention and fully recognizing the rural context as a vulnerable space. This intersectional argument, which emphasizes the ongoing, holistic responsibility of those involved in rural communities, draws on work from the domains of care ethics, relational ethics, pragmatic psychology, feminist ethics of embodiment, social location theory, and reflections on geographical narcissism.

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“…Ensure that rural healthcare systems identify the ethical responsibilities of the institution, focusing on the core domains of the healthcare system's mission. The overall ethics environment should facilitate and support ethical practices and support from the highest levels to equalize the power differential between physicians and others on the healthcare team (Morley and Beatty 2008;Vernillo 2008). Affirmative efforts must be taken to overcome these barriers and promote a climate of open communication without fear of retaliation or exclusion.…”

Section: Policy and Practice Strategies And Implicationsmentioning

confidence: 99%

“…Facilitate the means for rural systems to utilize the work done by other groups to promote shared decision making with patients and providers. These can be utilizing decision aids and educational materials (Vernillo 2008), and integrate principles of distributive justice with the pragmatic considerations of rural practice and virtue ethics attentive to the multiple relationships and perspective of rural communities (Klugman 2008).…”

Section: Policy and Practice Strategies And Implicationsmentioning

confidence: 99%