1. Rural Medical Ethics Rural Ethics HOW TO BE A MENSCH

2. Mensch “A person with integrity and honor”

3. Dimensions  Morality  Professionalism  Responsibility  Honesty  Respect  Empathy  Beneficence

4. 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/

5. 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

6. The Rural Challenge: Multi-level relationships  Physician  Family member  Business associate  Subordinate  Supervisor  Employer  Employee  Customer  Friend  Competitor  Teacher  Student  Reporter

7. 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

8. 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

9. 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

10. Prohibited Actions  Romantic/sexual relationships  Prescribing controlled substances  Privacy/confidentiality violations  Using knowledge to personal advantage  Ignoring reporting requirements

11. Cases:  What’s going on here?  What are the issues  How would you handle this situation?