Ethics of rural health care

One quarter of the US population live in areas designated as rural. Deliver y of rural health care can be difficult with unique challenges including li mited access to specialists such as oncologists. The Rural Cancer Outreach Program is an alliance between an academic medical center and five rural ho spitals. Due to the presence of this program, the appropriate use of narcot ics for chronic pain has increased, the number of breast conserving surgeri es has more than doubled and accrual to clinical trials has gone from zero to nine over the survey period. An increase in adjuvant chemotherapy has be en noted. The rural hospitals and the academic center have seen a positive financial impact. The most prominent ethical issues focus on justice, espec ially access to health care, privacy, confidentiality, medical competency, and the blurring of personal and profession boundaries in small communities . As medical care has become more complex with an increasing number of ethi cal issues intertwined, the rural hospitals have begun to develop mechanism s to provide help in difficult situations. The academic center has provided expertise and continued education for staff, both individually and within groups, regarding ethical dilemmas, (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.