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Vast Tracts of Land: Rural Healthcare Culture

Rurality in the modern United States (US) is characterized as a small population spread over a wide area of land. Only approximately 21% of the population lives in rural areas, which is defined as nearly 87% of all US territory (US Census Bureau 2002). The result of such demographics is that rural residents have a culture that is unique and different from their urban counterparts. When studying ethical standards and practices in unfamiliar regions, one must look ethnographically from the perspective of local knowledge and experience. Rural healthcare is not simply a new land for bioethics to claim and conquer, but rather an opportunity for new cultural understanding in terms of defining health, help-seeking behaviors, and moral certainty. In the target article, Cook and Hoas (2008) suggest that rural healthcare workers do not view certain scenarios as being “ethical” in nature and, likewise, they claim that bioethics does not see rural concerns as being “ethical.” Part of this discrepancy comes from the fact that only 11% of physicians practice and only 2% of members of the American Society for Bioethics and Humanities (Glenview, IL) work in rural areas (Nelson and Weeks 2006; US Department of Health and Human Services 1996). Even the professional literature on rural ethical issues is very lean (Nelson et al. 2006). Thus, in general, bioethicists and physicians have little experience in the rural setting.