Rural Health Care Ethics


Approximately 62 million people, one-quarter of the United States’ overall population, live in rural communities. Rural Americans have limited access to clinicians, health facilities, and specialized services, and their care is hampered by geographical and climatic barriers, as well as heightened social, cultural, and economic challenges.

The burden of illness for rural populations is considerable, placing great demands on a resource-poor clinical care system. Consequently, rural people are increasingly recognized as an underserved special population. Attaining an appropriate standard of care for the rural population has emerged as a major concern in the national discussion of health disparities.

Ethical Considerations in Rural Settings

Along with the growing understanding of concerns related to rural health care, is an emerging awareness of the special ethical considerations inherent to clinical and administrative practice in closely-knit, isolated, tightly interdependent, small rural community settings.

Rural health care ethics focuses on health care ethics uncertainty or conflicts occurring in the distinct context of the rural setting. What makes rural health care ethics is how the rural environment influences both the presentation and the response to ethics conflicts.

Rural Characteristics Influencing Ethics Issues:

  • Limited economic resources
  • Reduced health status
  • Limited availability and accessibility of health care services
  • Cultural and personal values
  • Dual and overlapping professional-patient relationships
  • Caregiver stress
  • Limited rural focused ethics resources

For a comprehensive discussion of issues in Rural Health Care Ethics, the Handbook for Rural Health Care Ethics: A Practical Guide for Professionals is available for free download.

Content credit: William Nelson, Rural Ethics Program, Dartmouth Medical School