Nelson W, Pomerantz A, Howard K, Bushy A
Community and Family Medicine, Dartmouth Medical School, HB 7251, Hanover, NH 03755, USA.
J Med Ethics. 2007 Mar;33(3):136-9. doi: 10.1136/jme.2006.015966.
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.
农村环境的独特背景给为其约6200万居民提供符合伦理的医疗保健带来了特殊挑战。尽管农村社区千差万别，但大多数具有以下共同特征：经济资源有限、价值观相同、健康状况较差、医疗保健服务的可获得性和可及性有限、专业人员与患者关系重叠以及护理人员压力大。这些农村特征形成了常见的医疗保健伦理问题，包括对保密性的威胁、边界问题、专业人员与患者的关系以及资源分配。迄今为止，农村医疗保健伦理受到的关注有限，这体现在农村医疗保健伦理文献稀少、农村伦理委员会、针对农村的伦理培训以及对农村伦理问题的研究匮乏。一个由具有医学、护理和哲学背景的农村医疗保健伦理学家组成的跨学科小组召开会议，探讨制定农村医疗保健伦理议程的必要性。在会议上，农村医疗保健伦理联盟商定了农村医疗保健伦理的定义以及一项广泛的农村伦理议程，其最终目标是提高美国农村地区的患者护理质量。拟议的议程要求通过与农村医疗保健专业人员、医疗机构和多样化的农村人口合作开展基于证据、适应农村情况的研究、学术活动和教育，来提高对农村医疗保健伦理的认识和理解。
