Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-nmvwc Total loading time: 0 Render date: 2024-06-17T00:49:31.391Z Has data issue: false hasContentIssue false

38 - Rural healthcare ethics

Published online by Cambridge University Press:  30 October 2009

By
William A. Nelson  and
Jared M. Schmidek
Edited by
Peter A. Singer  and
A. M. Viens
William A. Nelson
Affiliation:
Associate Professor Department of Community and Family Medicine Dartmouth Medical School, USA
Jared M. Schmidek
Affiliation:
Center for the Evaluative Clinical Sciences Dartmouth Medical School Hanover, USA
Peter A. Singer
Affiliation:
University of Toronto
A. M. Viens
Affiliation:
University of Oxford
Get access

Summary

A primary care physician that works in a small, remote hospital diagnoses a patient with lung cancer and refers the patient to a distant large medical center for treatment. After several overnight trips to the medical center, the patient returns to the primary care provider to indicate that she is no longer willing to travel and wants to receive care at the small hospital.

A rural psychologist, also a member of the town's school board, discovers during a family counseling session that one of the patients, a schoolteacher, has missed many teaching days because of a significant alcohol problem.

A family physician treats a long-term patient for a minor work-related injury. The patient is very depressed and tearful but refuses to discuss it. The physician encourages the patient to see a mental health professional to be further assessed and, if needed, receive treatment. The patient acknowledges feeling depressed but does not want help. If people see his truck at the mental health provider's office, everyone will know that he has “that” type of problem. The patient also requests that the physician not make any reference to depression in his medical record, because his sister-in-law works at the doctor's office.

Type
Chapter
Information
The Cambridge Textbook of Bioethics , pp. 289 - 298
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American College of Physicians (1998). Ethics manual: 4th edn, Ann Intern Med 128: 576–94.CrossRefGoogle Scholar
American Psychiatric Association (2006). The Principles of Medical Ethics: With Annotations Especially Applicable to Psychiatry, 2006 edn. Arlington, VA: American Psychiatric Association (http://www.psych.org/psych_pract/ethics/ppaethics.cfm) accessed 8 September 2006.Google Scholar
Baldwin, L. M., Patanian, M. M., Larson, E. H., et al. (2006). Modeling the mental health workforce in Washington State: using state licensing data to examine provider supply in rural and urban areas. J Rural Health 22: 50–8.CrossRefGoogle ScholarPubMed
Berger, J. and Mohr, J. (1967). A Fortunate Man. New York: Pantheon, pp. 13–5.Google Scholar
Bird D. C., Dempsey P., and Hartley D. (2001). Addressing Mental Health Workforce Needs in Underserved Rural Areas: Accomplishments and Challenges. [Working Paper No. 23.] Portland, ME: University of Southern Maine, Edmund S. Muskie School of Public Service, Institute for Health Policy, Maine Rural Health Research Center (http://www.muskie.usm.maine.edu/m_view_publication.jsp?id=954) accessed 8 September 2006.
Boffa, J. (2002). Is there a doctor in the house?Aust N Z J Public Health 26: 301–4.CrossRefGoogle Scholar
Braden, J. and Beauregard, K. (1994). Health Status and Access to Care of Rural and Urban Populations. National Medicare Expenditure Survey Findings 18. Rockville, MD: Agency for Health Care Policy and Research.Google Scholar
Bushy, A. (1994). When your client lives in a rural area. Part I: rural health care delivery issues. Issues Ment Health Nurs 15: 253–66.CrossRefGoogle Scholar
Bushy, A. and Rauh, J. R. (1991). Implementing an ethics committee in rural institutions. J Nurs Admin 21: 18–25.Google ScholarPubMed
Campbell, C. D. and Gordon, M. C. (2003). Acknowledging the inevitable: understanding multiple relationships in rural practice. Prof Psychol Res Pract 34: 430–4.CrossRefGoogle Scholar
Canadian Rural Partnership Research and Analysis Unit (2002). Rural Research Note: Canadian Rural Population Trends. [Publication 2138/E.] Ottawa: Government of Canada, Agriculture and Agri-Food Canada (http://www.rural.gc.ca/research/note/note1_e.phtml) accessed 8 September 2006.
Chan, C., Hart, L. G., and Goodman, D. C. (2006). Geographic access to health care for rural Medicare beneficiaries. J Rural Health 22: 140–6.CrossRefGoogle ScholarPubMed
Cook, A. F. and Hoas, H. (2000). Where the rubber hits the road: implications for organizational and clinical ethics in rural health care settings. HEC Forum 12: 331–40.CrossRefGoogle Scholar
Cook, A. F. and Hoas, H. (2001). Voices from the margins: a context for developing bioethics-related resources. Am J Bioethics 1: W12.Google ScholarPubMed
Cook, A. F., Hoas, H., and Guttmannova, K. (2000a). Bioethics activities in rural hospitals. Camb Q Healthc Ethics 9: 230–8.CrossRefGoogle Scholar
Cook, A. F., Hoas, H., and Joyner, J. C. (2000b). Ethics and the rural nurse: a research study of problems, values, and needs. J Nurs Law 7: 41–53.Google Scholar
Cook, A. F., Hoas, H., and Joyner, J. C. (2001). No secrets on Main Street. Am J Nurs 101: 67, 69–71.CrossRefGoogle ScholarPubMed
Cook, A. F., Hoas, H., and Guttmannova, K. (2002). Ethical issues faced by rural physicians. SDJ Med 55: 221–4.Google ScholarPubMed
Cox, J. (1997). Rural general practice: a personal view of current key issues. Health Bull (Edinb.) 55: 309–15.Google ScholarPubMed
Department for Environment, Food and Rural Affairs. (2004). Appendix B – Summary of evidence base. In The Rural Strategy 2004. London: defra (http://www.defra.gov.uk/rural/strategy/annex_b.htm) accessed 8 September 2006.
Economic Research Service (2005). Child poverty declined between 1990 and 2000. In Economic Information Bulletin Number 1: Rural Children at a Glance. Washington, DC: US Department of Agriculture (http://www.ers.usda.gov/publications/EIB1/EIB1.htm) accessed 8 September 2006.
Flannery, M. A. (1982). Simple living and hard choices. Hastings Cent Rep 12: 9–12.CrossRefGoogle ScholarPubMed
Forrow, L., Arnold, R. M., and Parker, L. S. (1993). Preventive ethics: expanding the horizons of clinical ethics. J Clin Ethics 4: 287–94.Google ScholarPubMed
Gallagher, E., Alcock, D., Diem, E., Angus, D., and Medves, J. (2002). Ethical dilemmas in home care case management. J Healthc Manag 47: 85–96.CrossRefGoogle ScholarPubMed
Gamm, L. D., Hutchinson, L. L., Dabney, B. J., and Dorsey, A. M. (eds.) (2003). Rural Healthy People 2010: A Companion Document to Healthy People 2010. College Station, TX: The Texas A&M University System Health Science Center, School of Rural Public Health, Southwest Rural Health Research Center.Google Scholar
Glover, J. J. (2001). Rural bioethical issues of the elderly: how do they differ from urban ones?J Rural Health 17: 332–5.CrossRefGoogle ScholarPubMed
Goldsmith, H. F., Wagenfeld, M. O., Manderscheid, R. W., and Stiles, D. (1997). Specialty mental health services in metropolitan and nonmetropolitan areas: 1983 and 1990. Admin Policy Mental Health 24: 457–88.Google ScholarPubMed
Hardwig, J. (2006). Rural health care ethics: what assumptions and attitudes should drive the research?Am J Bioethics 6: 53–4.CrossRefGoogle ScholarPubMed
Hartley D., Bird D., and Dempsey P. (1999). Rural mental health and substance abuse. In Rural Health in the United States, ed. Ricketts, T. C.. New York: Oxford University Press, pp. 159–78.Google Scholar
Henderson, C. B. (2000). Small-town psychiatry. Psychiatr Serv 51: 253–4.CrossRefGoogle ScholarPubMed
Holzer, C. E., Goldsmith, H. F., and Ciarlo, J. A. (1998). Effects of rural–urban county type on the available of health and mental health care providers. In Mental Health, United States. Washington, DC: US Government Printing Office [DHHS Pub. No. (SMA)99–3285], pp. 204–13.Google Scholar
Institute of Medicine (2005). Quality Through Collaboration: The Future of Rural Health Care. Washington, DC: National Academies Press.Google Scholar
Jennings, F. L. (1992). Ethics of rural practice. Psychother Private Pract 10: 85–104.Google Scholar
Johnson, M. E., Brems, C., Warner, T. D., and Roberts, L. W. (2006). Rural–urban health care provider disparities in Alaska and New Mexico. Adm Policy Ment Health 33: 504–7.CrossRefGoogle ScholarPubMed
Kelly, S. E. (2003). Bioethics and rural health: theorizing place, space, and subjects. Soc Sci Med 56: 2277–88.CrossRefGoogle ScholarPubMed
Larson, L. (2001). How many hats are too many?Trustee 54: 6–10.Google ScholarPubMed
Maddalena, V. and Sherwin, S. (2004). Vulnerable populations in rural areas: challenges for ethics committees. HEC Forum 16: 234–46.CrossRefGoogle ScholarPubMed
Miller, P. J. (1994). Dual relationships in rural practice: a dilemma of ethics and culture. Hum Serv Rural Environ 18: 4–7.Google Scholar
Moscovice, I. and Rosenblatt, R. (2000). Quality-of-care challenges of rural health. J Rural Health 16: 168–76.CrossRefGoogle ScholarPubMed
Moss, A. H. (1999). The application of the Task Force report in rural and frontier settings. J Clin Ethics 10: 42–8.Google ScholarPubMed
National Center for Health Statistics (2001a). Figure 3. Population by age, region, and urbanization level: United States, 1998. Data tables on urban and rural health. In Health, United States, 2001 with Urban and Rural Health Chartbook. Washington, DC: US Government Printing Office (DHHS Publ. No. (PHS) 01-1232), p. 93.Google Scholar
National Center for Health Statistics (2001b). Figure 19. Suicide rates among persons 15 years of age and over by sex, region, and urbanization level: United States, 1996–8. Data tables on urban and rural health. In Health, United States, 2001 with Urban and Rural Health Chartbook. Washington, DC: US Government Printing Office (DHHS Pub. No. (PHS) 01-1232), p. 109.Google Scholar
National Center for Health Statistics (2005). Table 33. Age-adjusted death rates, according to race, sex, region, and urbanization level: United States, average annual 1994–6, 1997–9, and 2000–2. In Health, United States, 2005 with Chartbook on Trends in the Health of Americans. Washington, DC: Government Printing Office (DHHS Pub. No. 2005-1232), p. 184.Google Scholar
Nelson, W. (2004). Addressing rural ethics issues. The characteristics of rural health care settings pose unique ethical challenges. Healthc Exec 19: 36–7.Google Scholar
Nelson, W. (2006). Where's the evidence: a need to assess rural health ethics committee models. J Rural Health 22: 193–5.CrossRefGoogle Scholar
Nelson, W. A. and Pomerantz, A. S. (1992a). Ethics issues in rural health care. Trustee 45: 14–15.Google Scholar
Nelson W. A. and Pomerantz A. S. (1992b). Ethics issues in rural health care. In Choices and Conflict: Explorations in Health Care Ethics, ed. Friedman, E.. Chicago, IL: American Hospital Publishers, pp. 156–63.Google Scholar
Nelson, W. A. and Weeks, W. B. (2006). Rural/non-rural differences of American Society of Bioethics and Humanities membership. J Med Ethics 32: 411–13.CrossRefGoogle Scholar
Nelson, W., Lushkov, G., Pomerantz, A., and Weeks, W. B. (2006). Rural health care ethics: is there a literature?Am J Bioethics 6: 44–50.CrossRefGoogle Scholar
Niemira, D. A. (1988). Grassroots grappling: ethics committees at rural hospitals. Ann Intern Med 12: 981–3.CrossRefGoogle Scholar
Niemira, D. A., Meece, K. S., and Reiquam, C. W. (1989a). Multi-institutional ethics committees. HEC Forum 1: 77–81.CrossRefGoogle Scholar
Niemira, D. A., Orr, R. D., and Culver, C. M. (1989b). Ethics committees in small hospitals. J Rural Health 5: 19–32.CrossRefGoogle Scholar
Purtilo, R. (1987). Rural health care: the forgotten quarter of medical ethics. Second Opin 6: 10–33.Google ScholarPubMed
Purtilo, R. and Sorrell, J. (1986). The ethical dilemmas of a rural physician. Hastings Cent Rep 16: 24–8.CrossRefGoogle ScholarPubMed
Ricketts, T. C. (2000). The changing nature of rural health care. Annu Rev Public Health 21: 639–57.CrossRefGoogle ScholarPubMed
Ricketts, T., Johnson-Webb, K., and Taylor, P. (1998). Rural Definitions for Health Policy Makers. Bethesda, MD: DHHS, Federal Office of Rural Health Policy.Google Scholar
Roberts L. W. and Dyer, A. R. (2004). Caring for people in small communities. In Concise Guide to Ethics in Mental Health Care, ed. Roberts, L. W. and Dyer, A. R.. Washington, DC: American Psychiatric Press, pp. 167–83.Google Scholar
Roberts, L. W., Battaglia, J., Smithpeter, M., and Epstein, R. S. (1999a). An office on main street: health care dilemmas in small communities. Hastings Cent Rep 29: 28–37.CrossRefGoogle Scholar
Roberts, L. W., Battaglia, J., and Epstein, R. S. (1999b). Frontier ethics: mental health care needs and ethical dilemmas in rural communities. Psychiatr Serv 50: 497–503.CrossRefGoogle Scholar
Roberts, L. W., Warner, T. D., and Hammond, K. G. (2005). Ethical challenges of mental health clinicians in rural and frontier areas. Psychiatr Serv 56: 358–9.CrossRefGoogle ScholarPubMed
Robillard, H. M., High, D. M., Sebastian, J. G., et al. (1989). Ethical issues in primary health care: a survey of practitioners' perceptions. J Community Health 14: 9–17.CrossRefGoogle ScholarPubMed
Romanow R. J. (2002). Building on Values: The Future of Health Care in Canada, Ch. 7: Rural and Remote Communities. Saskatoon: Commission on the Future of Health Care in Canada (http://www.hc–sc.gc.ca/english/care/romanow/hcc0023.html) accessed 19 September 2006.
Rosenblatt, R. A. and Hart, L. C. (1999). Physicians and rural America. In Rural Health in the United States, ed. Ricketts, T. C., III. New York: Oxford University Press, pp. 38–51.Google Scholar
Rosenthal, M. B., Zaslavsky, A., and Newhouse, J. P. (2005). The geographic distribution of physicians revisited. Health Serv Res 40: 1931–52.CrossRefGoogle ScholarPubMed
Rosenblatt, R. A., Andrilla, C. H. A., Curtin, T., and Hart, L. G. (2006). Shortages of medical personnel at community health centers: implications for planned expansion. JAMA 295: 1042–9.CrossRefGoogle ScholarPubMed
Rost, K., Owen, R. R., Smith, J., and Smith, G. R. (1998). Rural–urban differences in service use and course of illness in bipolar disorder. J Rural Health 14: 36–43.CrossRefGoogle Scholar
Rourke, L. L. and Rourke, J. T. (1998). Close friends as patients in rural practice. Can Fam Physician 44: 1208–10, 1219–22.Google ScholarPubMed
Schank, J. A. (1998). Ethics issues in rural counseling practice. Can J Counseling 32: 270–83.Google Scholar
Simon, R. I. and Williams, I. C. (1999). Maintaining treatment boundaries in small communities and rural areas. Psychiatr Serv 50: 1440–6.CrossRefGoogle ScholarPubMed
Sobel, S. B. (1992). Small town practice of psychotherapy: ethical and personal dilemmas. Psychother Private Pract 10: 61–9.Google Scholar
Spiegel, P. B. (1990). Confidentiality endangered under some circumstances without special management. Psychotherapy 27: 636–43.CrossRefGoogle ScholarPubMed
Sriram, T. G., Radhika, M. R., Shanmugham, V., and Murthy, R. S. (1990). Comparison of urban and rural respondents' experience and opinion of ethical issues in medical care. Int J Soc Psychiatry 36: 200–6.CrossRefGoogle Scholar
Turner, L. N., Marquis, K., and Burman, M. E. (1996). Rural nurse practitioners: perceptions of ethical dilemmas. J Am Acad Nurs Pract 8: 269–74.CrossRefGoogle ScholarPubMed
Ullom-Minnich, P. D. and Kallail, K. J. (1993). Physicians' strategies for safeguarding confidentiality: the influence of community and practice characteristics. J Fam Pract 37: 445–8.Google ScholarPubMed
US Department of Housing and Urban Development (2000). Attachment 2: FY 2000 Median Family Income for States, Metropolitan and Nonmetropolitan Portions of States. Washington, DC: Government Printing Office (http://www.huduser.org/DATASETS/IL/fmr00/medians2.html) accessed 18 September 2006.
Wagenfeld, M. O., Murray, J. D., Mohatt, D. F., and DeBruyn, J. C. (1994). Mental Health and Rural America: 1980–1993. An Overview and Annotated Bibliography. Washington, DC: HHSA, Office of Rural Health Policy.Google Scholar
Warner, T. D., Monaghan–Geernaert, P., Battaglia, J., et al. (2005). Ethical considerations in rural health care: a pilot study of clinicians in Alaska and New Mexico. Community Ment Health J 41: 21–33.CrossRefGoogle ScholarPubMed
Weeks, W. B., Kazis, L. E., Shen, Y., et al. (2004). Differences in health-related quality of life in rural and urban veterans. Am J Public Health 94: 1762–7.CrossRefGoogle ScholarPubMed
Woods, D. (1977). The rural doctor: among friends on the Canada–US border. CMAJ 117: 809, 812–14.Google ScholarPubMed
Ziller, E. C., Coburn, A. F., Loux, S. L., Hoffman, C., and McBride, T. D. (eds.) (2003). Health Insurance Coverage in Rural America: Chartbook. [Publication 4093] Washington, DC: Kaiser Commission on Medicaid and the Uninsured.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Rural healthcare ethics
    • By William A. Nelson, Associate Professor Department of Community and Family Medicine Dartmouth Medical School, USA, Jared M. Schmidek, Center for the Evaluative Clinical Sciences Dartmouth Medical School Hanover, USA
  • Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
  • Book: The Cambridge Textbook of Bioethics
  • Online publication: 30 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545566.044
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Rural healthcare ethics
    • By William A. Nelson, Associate Professor Department of Community and Family Medicine Dartmouth Medical School, USA, Jared M. Schmidek, Center for the Evaluative Clinical Sciences Dartmouth Medical School Hanover, USA
  • Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
  • Book: The Cambridge Textbook of Bioethics
  • Online publication: 30 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545566.044
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Rural healthcare ethics
    • By William A. Nelson, Associate Professor Department of Community and Family Medicine Dartmouth Medical School, USA, Jared M. Schmidek, Center for the Evaluative Clinical Sciences Dartmouth Medical School Hanover, USA
  • Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
  • Book: The Cambridge Textbook of Bioethics
  • Online publication: 30 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545566.044
Available formats
×