HEC Forum

, Volume 22, Issue 4, pp 267–274 | Cite as

The Presence of Ethics Programs in Critical Access Hospitals

  • William A. NelsonEmail author
  • Marie-Claire Rosenberg
  • Todd Mackenzie
  • William B. Weeks


The purpose of this study was to assess the presence of ethics committees in rural critical access hospitals across the United States. Several studies have investigated the presence of ethics committees in rural health care facilities. The limitation of these studies is in the definition of ‘rural hospital’ and a regional or state focus. These limitations have created large variations in the study findings. In this nation-wide study we used the criteria of a critical access hospital (CAH), as defined by the Medicare Rural Hospital Flexibility Program (Flex Program, 2007), to bring consistency and clarity to the assessment of the presence of ethics committees in rural hospitals. The Flex Monitoring Team conducted a national telephone survey of 381 CAH administrators throughout the United States. The survey covered a wide variety of questions concerning hospitals’ community benefit, impact activities, and whether the hospital had a formally established an ethics committee. About 230 (60%) of the respondents indicated they had a formally established ethics committee or ethics consultation program at their CAH. The prevalence of ethics committees declined as the CAH location became increasingly rural along a rural–urban continuum. Unlike CAHs, all rural Department of Veterans Affairs Medical Centers have ethics committees. The results of this study provide an understanding of the limited presence of ethics committee in rural America and the need to consider new approaches for providing ethics assistance. A virtual ethics committee network may be the most efficient and effective way of providing rural hospitals access to a knowledgeable ethics committee or consultant.


Rural ethics Ethics committees Health care ethics Rural hospitals Critical access hospitals 



This work was partially supported by the Veterans Rural Health Resource Center—Eastern Region, White River Junction, Vermont. The views expressed in this article do not necessarily represent the Department of Veterans Affairs or the United States government. We gratefully acknowledge Dr. Andrew Coburn, Mr. John Gale and their colleagues at the Maine Rural Health Research Center at the University of Southern Maine for gathering the data used in this research paper. We also acknowledge the assistance of Mary Ann Greene, MS in providing bibliographic research assistance.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • William A. Nelson
    • 1
    Email author
  • Marie-Claire Rosenberg
    • 2
  • Todd Mackenzie
    • 3
  • William B. Weeks
    • 4
  1. 1.Community and Family Medicine and The Dartmouth Institute for Health Policy and Clinical Practice Dartmouth Medical SchoolLebanon, HanoverUSA
  2. 2.College of NursingNew York UniversityNew YorkNew York
  3. 3.Biostatistics and Epidemiology Section, Community and Family MedicineDartmouth Medical SchoolHanoverUSA
  4. 4.The Office of Professional Education and OutreachLebanonUSA

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