Ethical Issues in Rural Health Care

by Craig M. Klugman, Pamela M. Dalinis

Overview

Klugman and Dalinis initiate a much-needed conversation about the ethical and policy concerns facing health care providers in the rural United States.

This volume initiates a much-needed conversation about the ethical and policy concerns facing health care providers in the rural United States. Although 21 percent of the population lives in rural areas, only 11 percent of physicians practice there. What challenges do health care workers face in remote locations? What are the differences between rural and urban health care practices? What particular ethical issues arise in treating residents of small communities? Craig M. Klugman and Pamela M. Dalinis gather philosophers, lawyers, physicians, nurses, and researchers to discuss these and other questions, offering a multidisciplinary overview of rural health care in the United States.

Rural practitioners often practice within small, tight-knit communities, socializing with their patients outside the examination room. The residents are more likely to have limited finances and to lack health insurance. Physicians may have insufficient resources to treat their patients, who often have to travel great distances to see a doctor.

The first part of the book analyzes the differences between rural and urban cultures and discusses the difficulties in treating patients in rural settings. The second part features the personal narratives of rural health care providers, who share their experiences and insights. The last part introduces unique ethical challenges facing rural health care providers and proposes innovative solutions to those problems.

This volume is a useful resource for bioethicists, members of rural bioethics committees and networks, policy makers, teachers of health care providers, and rural practitioners themselves.

Product Details

ISBN-13:	9781421409559
Publisher:	Johns Hopkins University Press
Publication date:	01/02/2013
Series:	Bioethics
Edition description:	New Edition
Pages:	240
Product dimensions:	5.90(w) x 8.90(h) x 0.70(d)
Age Range:	18 Years

About the Author

Craig M. Klugman is the Stewart & Marianne Reuter Professor of Medical Humanities and assistant director for ethics education at the Center for Medical Humanities and Ethics at the University of Texas Health Science Center, San Antonio.

Pamela M. Dalinis is senior associate director, DIVACO Education, The Joint Commission, Oakbrook Terrace, Illinois.

Table of Contents

List of Contributors ix

Preface xi

Introduction Craig M. Klugman Pamela M. Dalinis 1

Part I Overview of Rurality and General Ethical Issues

1 Rural-Urban Differences in End-of-Life Care: Reflections Social Contracts Charles E. Gessert 15

2 The Challenges of Rural Health Care William A. Nelson 34

3 Ethics, Errors, and Where We Go from Here Ann Freeman Cook Helena Hoas 60

4 The Ethics of Allocating Resources toward Rural Health and Health Care Marion Danis 71

Part II Practitioners' Voices

5 Reflections on Fifty Years in Rural Health Care Elwood L. Schmidt 99

6 Serving the Underserved: Personal, Social, and Medical Challenges Louis Borgenicht 105

7 Ethical and Sociocultural Issues in Rural Mental Health Care Dan Goodkind 110

Part III Specific Ethical Issues and Solutions

8 Ethical Dimensions of the Quality of Rural Health Care Denise Niemira 119

9 Building Bioethics Networks in Rural States: Blessings and Barriers Frank Chessa Julien S. Murphy 132

10 Structural Violence in the Rural Context: The Ethical Implications of Welfare Reform for Rural Health Elizabeth A. Thomas 154

11 Rural Geriatric Bioethics: A Texas Perspective William J. Winslade Martha Beard-Duncan 167

12 Supporting the Rural Physician: Processes and Programs Jamie Anderson Craig M. Klugman 185

Index 219

What People are Saying About This

Ruth B. Purtilo

This volume elucidates a wide range of ethical issues and the authors provide helpful strategies for practice and policy.

— Ruth B. Purtilo, Massachusetts General Hospital Institute of Health Professions

From the Publisher

This volume elucidates a wide range of ethical issues and the authors provide helpful strategies for practice and policy.
—Ruth B. Purtilo, Massachusetts General Hospital Institute of Health Professions

Editorial Reviews

Of obvious value for those active in rural health care. It may be even more useful, however, for nonrural practitioners, ethicists, and members of ethics committees. Reading the essays in this volume is like acquiring a new set of glasses. It made me better able to perceive differences in how ethics can be considered based on culture, population, geographic challenges, and personal connections . . . An even bigger service may be the tools it provides to look differently at problems commonly thought to be understood.
—Myles N. Sheehan, SJ, MD, JAMA

An excellent scholarly examination of what rural people face in the world of health care.
—Midwest Book Review

A welcome addition to this oft-neglected area of ethics. The collection is broad-ranging and well-designed.
—Robert Macauley , Journal of Bioethical Inquiry

The common thread among the essays is a bioethical perspective. Their common goal is to raise awareness among rural practitioners and other interested parties about the particular challenges that the rural environment presents.
—Health Affairs

From the Publisher

The common thread among the essays is a bioethical perspective. Their common goal is to raise awareness among rural practitioners and other interested parties about the particular challenges that the rural environment presents.

Health Affairs

Of obvious value for those active in rural health care. It may be even more useful, however, for nonrural practitioners, ethicists, and members of ethics committees. Reading the essays in this volume is like acquiring a new set of glasses. It made me better able to perceive differences in how ethics can be considered based on culture, population, geographic challenges, and personal connections . . . An even bigger service may be the tools it provides to look differently at problems commonly thought to be understood.

JAMA - Myles N. Sheehan

A welcome addition to this oft-neglected area of ethics. The collection is broad-ranging and well-designed.

Journal of Bioethical Inquiry - Robert Macauley

A welcome addition to this oft-neglected area of ethics. The collection is broad-ranging and well-designed.

— Robert Macauley

Journal of Bioethical Inquiry

Of obvious value for those active in rural health care. It may be even more useful, however, for nonrural practitioners, ethicists, and members of ethics committees. Reading the essays in this volume is like acquiring a new set of glasses. It made me better able to perceive differences in how ethics can be considered based on culture, population, geographic challenges, and personal connections... An even bigger service may be the tools it provides to look differently at problems commonly thought to be understood.

— Myles N. Sheehan, SJ, MD

JAMA

An excellent scholarly examination of what rural people face in the world of health care.

Midwest Book Review

Reviewer: Aaliyah Eaves-Leanos, JD (Saint Louis University)
Description: The editors bring together multidisciplinary bioethicists with geographically diverse experiences to cover an array of ethics issues that emerge in the delivery of healthcare in rural locations.
Purpose: The bioethics literature has paid little attention to the ethical challenges of providing rural medicine. As a result, rural healthcare practitioners lack meaningful ethics resources while their urban counterparts superficially grasp the particular ethical and policy issues inherent in this unique healthcare delivery context. The purpose of this book is to initiate a much-needed conversation about the intersection of ethics and healthcare in rural settings.
Audience: It is intended as a resource for bioethicists, members of rural ethics committees, policy makers, healthcare providers, and educators. Although the book is written for readers with a basic foundation in bioethics and healthcare delivery systems, anyone interested in rural medicine or cultural studies may also find it of interest.
Features: The book is organized into three well crafted and straightforward sections. Part one explores the difference between urban and rural culture from a descriptive framework and analyzes the ethical implications. Part two uses narratives from rural healthcare providers to articulate insights and experiences that can only be captured by an insider. The final section provides examples of specific ethical challenges faced by rural healthcare providers and offers solutions.
Assessment: This book should engage anyone with an interest in rural medicine, distributive justice, and cultural competency issues in healthcare. The chapters are relevant, unified, and appropriately accessible to the diverse readership that comprises the multidisciplinary study of bioethics. It does not provide a robust scholarly analysis of the issues or sufficiently detailed solutions to resolve all of the problems. Nonetheless, the authors have successfully provided a timely work on a frequently overlooked area of healthcare ethics. The book provides a rich starting point for the conversation and clearly identifies where more work needs to be done.

Doody's Review Service