Ethics Conflicts in Rural Communities: Allocation of Scarce Resources

Allocation of scarce resources is a reality for health care professionals and organizations. Resource allocation issues can be particularly challenging for rural communities, where resources are not enough to meet all needs and fewer alternatives exist to resolve conflicts between competing needs. In addition, the ramifications of decisions may be more visible in the rural setting. Decisions regarding allocation of resources can be troubling for clinicians and administrators to make, at both the personal and professional levels. Such decisions can be at odds with providers’ deeply held beliefs about benefiting others without harm. Resource allocation decisions can create conflicts for personal, professional, organizational, and community priorities and commitments. Though resource allocation issues are economic in nature, they inherently raise issues relating to organizational mission and ethics. The philosophical method chosen to resolve resource allocation conflicts can influence both the way in which decisions are framed, and how the decisions are made. When responding to resource allocation conflicts, it is difficult to prioritize and identify a primary fiduciary duty or responsibility. Resource allocation conflicts are characterized by multiple constituencies, complex relationships, and myriad benefits and harms—which may or may not be apparent. All of these factors make resolving ethics conflicts related to scarce resources in rural settings both difficult and emotionally troubling. Allocation of Scarce Resources 167