School of Rural Health (Dubbo/Orange), Faculty of Medicine and Health, The University of Sydney, Dubbo, NSW, Australia.
J Bioeth Inq. 2023 Jun;20(2):181-190. doi: 10.1007/s11673-023-10243-w. Epub 2023 Mar 28.
It is presently unclear whether a distinct "rural ethics" of navigating professional boundaries exists, and if so, what theoretical approaches may assist practitioners to manage overlapping relationships. To be effective clinicians while concurrently partaking in community life, practitioners must develop and maintain safe, ethical, and sustainable therapeutic relationships in rural and remote healthcare. A narrative review was conducted identifying a significant body of qualitative and theoretical literature which explores the pervasiveness of dual relationships for practitioners working in rural and remote healthcare. Rather than viewing dual relationships as ethically unacceptable, much contemporary work focusses on the lived experiences of healthcare workers and explores what approaches may be available that both protect the therapeutic relationship while recognizing the unique nature of rural and remote healthcare practice. We conclude that practitioners must have a means of operating within a contextually informed ethics of professional boundaries. Drawing on pre-existing work, one schema is proposed that could form the basis for further engagement through interactive teaching sessions, professional development, mentoring, or guidelines.
目前尚不清楚是否存在一种独特的“农村伦理”来规范专业界限，如果存在，那么哪些理论方法可以帮助从业者来管理重叠的关系。为了成为有效的临床医生，同时参与社区生活，从业者必须在农村和偏远地区的医疗保健中发展和维持安全、合乎道德和可持续的治疗关系。本文进行了一次叙述性回顾，确定了大量的定性和理论文献，这些文献探讨了在农村和偏远地区医疗保健工作的从业者中普遍存在的双重关系。与其将双重关系视为不道德的，许多当代作品更关注医疗工作者的生活经历，并探讨了哪些方法可以在保护治疗关系的同时，认识到农村和偏远地区医疗保健实践的独特性。我们的结论是，从业者必须有一种在具有背景信息的专业界限伦理框架内运作的方法。本文借鉴现有的工作，提出了一个方案，可以通过互动教学、专业发展、指导或指导方针进一步参与。
