Article Text

Download PDFPDF
A proposed rural healthcare ethics agenda
  1. W Nelson1,
  2. A Pomerantz2,
  3. K Howard3,
  4. A Bushy4
  1. 1Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA
  2. 2Mental Health Service, VA Medical Center, Vermont, USA
  3. 3VA Futures Group, VA Medical Center, Vermont, USA
  4. 4University Central Florida School of Nursing, Orlando, Florida, USA
  1. Correspondence to:
 W Nelson
 Community and Family Medicine, Dartmouth Medical School, HB 7251, Hanover, NH 03755, USA; william.a.nelson{at}


The unique context of the rural setting provides special challenges to furnishing ethical healthcare to its approximately 62 million inhabitants. Although rural communities are widely diverse, most have the following common features: limited economic resources, shared values, reduced health status, limited availability of and accessibility to healthcare services, overlapping professional–patient relationships and care giver stress. These rural features shape common healthcare ethical issues, including threats to confidentiality, boundary issues, professional–patient relationship and allocation of resources. To date, there exists a limited focus on rural healthcare ethics shown by the scarcity of rural healthcare ethics literature, rural ethics committees, rural focused ethics training and research on rural ethics issues. An interdisciplinary group of rural healthcare ethicists with backgrounds in medicine, nursing and philosophy was convened to explore the need for a rural healthcare ethics agenda. At the meeting, the Coalition for Rural Health Care Ethics agreed to a definition of rural healthcare ethics and a broad-ranging rural ethics agenda with the ultimate goal of enhancing the quality of patient care in rural America. The proposed agenda calls for increasing awareness and understanding of rural healthcare ethics through the development of evidence—informed, rural-attuned research, scholarship and education in collaboration with rural healthcare professionals, healthcare institutions and the diverse rural population.

  • ASBH, American Society of Bioethics and Humanities

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests: None.

  • Members of coalition for rural healthcare ethics: Angeline Bushy, University of Central Florida; Ann Cook, University of Montana; Jacqueline Glover, University of Colorado; William Nelson, Dartmouth Medical School; Denise Niemira, MD, Newport, VT; Andrew Pomerantz, VAMC White River Junction, VT; Dartmouth Medical School; Laura Roberts, Medical College of Wisconsin; Tom Townsend, East Tennessee State University.

    The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs or of the US government.

Other content recommended for you