Special Section: Bioethics Education

Rural Healthcare Ethics: No Longer the Forgotten Quarter


The rural health context in the United States presents unique ethical challenges to its approximately 60 million residents, who represent about one quarter of the overall population and are distributed over three-quarters of the country’s land mass. The rural context is not only identified by the small population density and distance to an urban setting but also by a combination of social, religious, geographical, and cultural factors. Living in a rural setting fosters a sense of shared values and beliefs, a strong work ethic, self-reliance, and a tendency for close-knit extended social structures where overlapping relationships are commonplace.

William Nelson, Ph.D., is an associate professor in the Department of Community and Family Medicine and director of the Dartmouth Medical School’s Rural Ethics Initiative, Hanover, New Hampshire.

Mary Ann Greene, M.S., is a research associate at the Dartmouth Medical School, Hanover, New Hampshire.

J. Westly McGaughey, B.A., is Research Analyst, Grants and Study, in the Program in Medicine & Human Values, California Pacific Medical Center, San Francisco.


This work was supported by the Rural Resource Center, White River Junction, Vermont. The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs or of the United States government.