1. Anticipating Ethics Conflicts Most ethics conflicts are recurring, that is, the basic ethics issue is recurring, such as end-of- life conflicts or boundary conflicts Training materials from Rural Health Care Ethics: A Manual for Trainers. WA Nelson and KE Schifferdecker, Dartmouth Medical School, Hanover, NH 42

2. Anticipating Ethics Conflicts Because ethics conflicts are frequently recurring conflicts And have significant negative impact on the organizations, staff and patients Rural professionals should develop strategies to anticipate and potentially reduce the impact of ethics conflicts 43

3. Interventions to Decrease Ethical Conflicts Facilitate a root cause analysis following ethics conflicts Identify cause of conflict Consider and embrace corrective actions Develop a proactive approach to ethics to address recurring ethical conflicts Identify ethical challenges throughout the organization or clinic Develop and propagate ethical practice guidelines to decrease there impact 44

4. Apply a Proactive Approach to Ethics Conflicts Use quality improvement approaches Establish clinical and organizational ethical practice guidelines Direct activities to enhance the quality of care and the practice’s overall culture 45