Rural Health EthicsRural Health EthicsJanuary 9, 2008January 9, 2008

Maria Wallington, MDMaria Wallington, MDMedical EthicistMedical Ethicist

Providence Health and Services AlaskaProvidence Health and Services Alaska

EtiquetteEtiquette

• Press * 6 to mute; • Press # 6 to un-mute• Keep your phone on mute unless you are

dialoging with the group• Never place phone on hold• If you do not want to be called on please

check the red mood button on the lower left of screen

Goals for today’s conversationGoals for today’s conversation

• Why talk about Rural Health Ethics?• What makes Rural Health Ethics different?• What are the major issues?• Example cases

Why talk about Rural Health Why talk about Rural Health Ethics?Ethics?

• Neglected population?• Are the issues different?

– In Kind?– In Degree?– Ethically?

What makes Rural Health Ethics What makes Rural Health Ethics different?different?

• Technology not the source of most issues• Demographics

– Older, poorer, – Communal or culturally distinct

• Availability of resources• Distances

Major IssuesMajor Issues

• Boundaries• Confidentiality• Providers

– Limited selection– Call coverage– Specialists– Alternate providers

• Distances– Access to care– Isolation form family/support

Major IssuesMajor Issues

• Need for transport– Expense– Availability/timeliness– Danger?

• Organizational issues– Whose responsible?– Service line decisions– Economic realities

• Ethics function needs and support

Case 1Case 1

• A small city (3000) owns its small hospital and long term care facility and contracts with a long health system to run its facilities. The facilities are major employers for the town.

• The administrator is trying to create a balanced budget and is considering reducing FTEs or raising rates for services.

Case 1 continuedCase 1 continued

• The chief administrator’s administrative assistant is the city’s mayor.

• The renewal of the contract is up for discussion

Case 2Case 2

• A small community in a farming area used the local radio to give “The Hospital Report” which announced who was in the hospital that day. Locals used the program to learn who needed an extra hand with the live stock and who might need a casserole to feed the kids while mama was in the hospital.

Case 2 continuedCase 2 continued

• HIPAA regulations brought the radio report to an end, much to the upset of the community. “What do the feds know about what makes our town work anyway?”

Fryer-Edwards, Kelly, “On Cattle and Casseroles”. Amer. Journal of Bioethics, March-April 2006,Vol. 6 Number 2, pp 55-56