In: Craig M. Klugman and Pamela M. Dalinis, (eds). Ethical Issues in Rural Health Care. Baltimore: The Johns Hopkins University Press, 2008.
Throughout their training and careers, healthcare providers are reminded of the primacy of the ethical prescriptive: “do no harm.” In spite of both rigorous training and best intentions, however, harm does occur. Harm, for example, can result from errors in diagnosis or treatment. Indeed if included on the National Center for Health Statistics’ list of the top ten causes of death, error would rank number five, well ahead of accidents, diabetes, Alzheimer disease, AIDs, breast cancer, and gunshot wounds.[i]
This chapter discusses the intersection between ethics and errors in rural healthcare settings. The discussion is based on findings obtained from a series of patient safety studies, conducted during a four-year period, among physicians, nurses, pharmacists, and administrators who work in rural hospitals and Indian Health Service settings in a 9-state area of the West. The methodology for these studies includes surveys, interviews, questionnaires, and textual analysis of responses to bi-weekly case studies. That multi-layer approach sheds light on the personal, professional, and organizational factors that influence the willingness of healthcare providers to take action when encountering situations that heighten the risk of error.
The findings from these studies underscore the need to implement processes and protocols that: (1) nurture a greater awareness of broadly defined, bioethics-related issues, (2) mitigate fears associated with recognition and disclosure of such issues, (3) promote acceptance of personal responsibility for actions and choices, and (4) encourage a willingness to act in ways that demonstrably improve the healthcare environment.