This paper sets out to explore the key ethical issues experienced by doctors in a rural setting and a) to create an educational resource for medical students and b) to contribute to the call for a ‘NZ  agenda of rural medical ethics and to influence the development of appropriate guidelines and standards’. The rapid review method was used due to the limited availability of the first author and the recent Cochrane Rapid Review Methods Group recommendations (2023) were followed. In keeping with the limitations of the method just 3 major databases were searched and 12 papers were selected from an initial 515 studies.

Key ethical issues were grouped into 5 main categories:

1. the overlapping relationships between doctors and their patients that are seen as inevitable in rural communities and that require ‘juggling’ of professional and personal roles, sometimes to the detriment of the doctors and their families,

2. managing friendships with patients although in urban-centric ethical guidance it is recommended that doctors keep professional and personal relationships separate, a situation that would result in social isolation in rural settings where most doctors live among their patients,

3. rural doctors experience loss of privacy and anonymity when well-known in the area and at times this can become intrusive

4.there is recognition of the need to pay particular attention to maintaining confidentiality when living and practising in the same area as patients

5. in under-resourced rural areas doctors can find themselves having to undertake interventions without having adequate training because there is no one else available, and this situation is exacerbated by the difficulties rural doctors find in accessing postgraduate training.

In summary this is an interesting and engaging paper that will resonate with all rural doctors and be a useful resource for medical students. It is hoped that it will inform the development of extended NZ ethical guidance that will incorporate the ‘lived reality’ and challenges of rural practice.

This paper was produced during a summer studentship (first author) and suggests that the rapid review method is a useful way of developing research skills in undergraduates.

OPEN ACCESS https://doi.org/10.1071/HC23069

Abstract

Introduction: Key New Zealand ethical documents that describe appropriate ethical behaviour for doctors do not consider rurality and how this might impact on the practice of medicine.

Aim: The aim of this study was to understand the literature on key ethical issues experienced by general practitioners in a rural context that might inform the development of a New Zealand agenda of rural medical ethics

Methods: A rapid review was undertaken of three databases using a variety of key words relating to rurality, ethics, professionalism and medicine. Inclusion criteria were research articles focussing on the experience of doctors working in a rural healthcare setting, commentaries and narratives. The findings from the paper were synthesised and broad ethical categories created.

Results: Twelve studies were identified that met the inclusion and exclusion criteria. Synthesis of the data revealed five ethical issues that predominately arose from living and working within communities. These ethical issues related to juggling personal and professional lives, managing friendships with patients, managing loss of privacy and anonymity, assuring confidentiality and practicing outside of comfort zones.

Discussion: The majority of ethical issues arose from managing overlapping relationships. However, these overlapping relationships and roles are considered normal in rural settings. A tension is created between adhering to urban normative ethical guidelines and the reality of living in a rural environment. Professional ethical guidelines, such as those developed by the New Zealand Medical Council, do not account for this rural lived reality. Rural practitioners in New Zealand should be engaged with to progress a specific rural ethics agenda.