Rural bioethical issues of the elderly: how do they differ from urban ones?

Typical ethical issues in health care for the elderly include decision making for elderly patients with and without capacity, advance directives, the use of life-sustaining technologies, and questions of access to services and justice. Obviously the same issues are relevant for elderly patients in rural settings. But the unique features of rural living add another dimension to ethical discourse and the care of patients, namely the primary importance of relationships. Rural bioethics is based on an ethic of familiarity, which alters our attention to such issues as confidentiality, multiple relationships, scope of practice, and access issues. The following article briefly outlines the unique features of rural bioethics and provides a case analysis.