Transcript A (Quick) History of Healthcare Ethics Why It Matters

Health Care Ethics in
the Rural Context
Why It Matters
James Stewart, MS
A (Quick) History of Health Care Ethics
• 5th Century B.C. Hippocrates
• 1847 American Medical Association Code of
Ethics
• 1960s-1970s A combination of circumstances
and events move health care ethics into the
public view
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Tuskegee Syphilis Study
Medical Technology and Skills
Bioethics:
The integration of biology and values into a
mechanism to shape the values of science in a
service of human and environmental well-being.
Terminology and Concepts
Morality: Shared beliefs about right and wrong
conduct in a culture or society.
Ethics: A systemic analysis of moral action
which justifies a position through rational
arguments and reflection.
Ethics is how we should act in consideration of others,
not how we believe or feel.
Health Care Ethics Issues:
Situations or circumstances embedded with questions of morality
that require attention and reflection to assure continuing on a path
consistent with the correct moral direction.
Health Care Ethics Problems:
• There is no way to act in a situation without
something of moral worth being compromised.
• Ethics Conflict or Dilemma:
Occurs when faced with two alternatives that are
mutually exclusive; two or more ethically required
courses of action diverge.
• Ethics Distress:
The result of knowing the “right” course of action
but feeling constrained to act by external influences
often a challenge to personal or professional
integrity.
Core Health Care Ethics
Principles or Obligations
A system of health care ethics constructed around
a set of principles generally recognized and
understood.
Beneficence
Nonmaleficence
Respect for Autonomy
Justice
Beneficence
• Benefiting others, doing good for others,
preventing harm
• Requires action
• Action must be conducted with the patient’s best
interest as the top priority
Nonmaleficence
• Refraining from harming others
• Obligation not to harm corresponds to a right of
the other person not to be harmed
Exceptions for extraordinary circumstances:
Self-Defense
War
Respect for Autonomy
• Self-rule; self determination
• Recognizing a person’s right to choose regarding
healthcare
Informed Consent
End-of-Life Decisions
Justice
Fair distribution of goods, benefits, burdens,
services; ensuring fair processes in policies and
laws; compensating for wrongs that have been
done
Rationing
Socioeconomic factors of health
Ethics theories and principles
provide a framework for the
decision-maker to guide the
resolution of medical ethics
problems.
What is “Rural”?
• No consensus on an “official” definition.
• Approximately one-fifth of the overall U.S.
population.
• Distributed over more than three-quarters of the
U.S. land mass.
Rural is small populations spread over vast
distances (in the Western U.S. anyway).
Rural Health
• Only 10% of physicians practice in rural areas.
• Rural residents have a lower per capita income
and are more likely to live below the poverty
line; nearly 24% of rural children live in poverty.
• Between 57% and 90% of first responders in
rural areas are volunteers.
Abuse of tobacco by rural adults is higher
• Significantly higher among rural youth; 26%
of rural 8th graders v. 12.7% of urban youth.
Alcohol abuse by rural inhabitants is higher
• 40% of rural 12th graders reported using
alcohol while driving v. 25% of urban
youth.
Seat belt use in rural areas reported as
77.6% v. 88% nationally.
Motor vehicle related deaths in rural areas
more than twice the rate in urban areas.
Rural citizens are nearly twice as likely to
die from unintentional injuries (other
than motor vehicle accidents).
Rural Residents have higher rates of:
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Obesity
Hypertension
Diabetes
Cerebrovascular disease
Higher death rates from ischemic heart disease
and COPD.
The suicide rate among rural males is significantly
higher than urban males and escalating rapidly
among rural females.
Shortage of All Rural
Health Care Providers
• Doctors
• RNs/NPs
• PAs
• Dentists
• Pharmacists
• Mental Health
Care Services
• Social Workers
The Rural Good Life
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Peaceful
Low crime
Physical beauty
Strong family and community ties
Health care providers held in high esteem
Freedom
Clean air
Abundance of nature
Rural Culture/Society
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Hardy/tough
Independent
Self-sufficient
Stoic
Strong community identification and allegiance
Traditional/conservative values
Definitions of Health
WHO: A state of complete physical, mental and
social well-being and not merely the absence of
disease or infirmity.
MERRIAM-WEBSTER: the condition of being
well or free from disease; the condition of being
sound in body, mind, or spirit; especially: free
from physical disease or pain.
Rural Definition of Health
The ability to work, to do daily chores without
regard to how a person feels.
Health means HARDINESS.
Financial/Economic
Implications
Dual and Overlapping
Relationships
Boundary Issues
Shared
Decision
Making
Rural
Health
Culture
Isolation
Privacy and
Confidentiality
Cultural and
Personal Values
Caregiver
stress
Limited Resources
and Access
Dual and Overlapping Relationships
Multiple relationships with community members
• Daily contact
• Schools/Kids
• Store clerks, waitresses, town mechanic, pastor,
etc.
• Social and civil organizations
• Generations of service
Privacy and Confidentiality
• Intentional and unintentional
• Patient reluctance
• Provider reluctance
• Breach can be devastating
Provider Stress and Burnout
• Overlapping relationships
• Immense clinician responsibilities
• Geographic and professional isolation
• Lack of resources
Why It Matters
Likely you will have a patient or contact with rural
provider.
You may live or relocate to a rural area.
Telemedicine or other technological interactions.