From bench to bedside: Putting practical ethics on the road in rural North Carolina.

摘要

Spectacular achievements in diagnostic and therapeutic medical technology, beginning in the mid-20th century, opened the door to both medical progress and the inherent moral ambiguities and potential harms co-existing with that progress. Technologies like CPR and mechanical ventilation created new ethical minefields for medicine and society. Bioethics grew out of efforts to understand and manage the issues of conscience raised by these new therapies. Although it now has a national presence and a large footprint in academic health care, bioethics has a minimal presence in small rural and community hospitals, which serve nearly a third of the American population. Rural hospitals and rural professionals face a unique set of ethical challenges stemming from the characteristics of rural culture and limited access to technology, continuing education, and supportive resources like bioethics training and expertise. In this thesis I explore these challenges. I examine ethics networking as a vehicle for reaching out to rural providers with ethics education, training and consultative services. I survey several rural hospitals with a de novo instrument created to assess their needs for ethics resources and to gauge their interest in the network concept. Finally I offer a proposal for the development of an ethics network that would link the deep ethics expertise in academia with rural hospitals that lack access to ethics resources.