Rural Medical EthicsRural Ethics

HOW TO BE A MENSCH

Mensch

“A person with integrity and honor”

Dimensions Morality Professionalism Responsibility Honesty Respect Empathy Beneficence

Professionalism

… the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769526/

ACGME requirements

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:

• Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development

• Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices

• Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities

The Rural Challenge:Multi-level relationships

Physician Family member Business associate Subordinate Supervisor Employer Employee Customer

Friend Competitor Teacher Student Reporter

The Rural Goal:

Identify and manage multilevel relationships by establishing and maintaining acceptable personal boundaries

Acceptable relationships and personal boundaries are likely to vary from person-to-person and situation-to-situation

Issues in Treating Friends, Family and Employees

Objectivity Adequacy of the location of treatment Access expectations Thoroughness of follow-up Financial expectations Empathy Confidentiality Rejection

Ways to Set Boundaries

Declare the framework of the care Choose the location of the care and the follow-up Explain what you can and cannot do legally/ethically When dilemmas arise:

Consult Establish and use a local ethics committee

Prohibited Actions

Romantic/sexual relationships Prescribing controlled substances Privacy/confidentiality violations Using knowledge to personal advantage Ignoring reporting requirements

Cases:

What’s going on here?What are the issuesHow would you handle this situation?