Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.

The Canadian Truth and Reconciliation Commission has been mandated to collect testimonies from survivors of the Indian Residential Schools system. The TRC demands survivors of the residential school system to share their personal narratives under the assumption that the sharing of narratives will inform the Canadian public of the residential school legacy and will motivate a transformation of settler identity. I contend, however, that the TRC provides a concrete example of how a politics of recognition fails to transform relationships between (...) Native and settler Canadians not only because it enacts an internalization of colonial recognition, but because it fails to account for what I call “settler ignorance.” Work in epistemologies of ignorance and epistemic oppression gives language to explain sustained denial and provide tools to further understand how settler denial is sustained, and how it can be made visible, and so challenged. For this task, Mills’s articulation of white ignorance should be expanded to a consideration of white settler ignorance. Over and above an account of white ignorance, such an account will have to consider the underlying logics of settler colonialism. This characterization of settler ignorance will show that the denial of past and ongoing violence against Indigenous peoples, through the reconstruction of the past to assert the primacy of settlers, is not explainable in terms of a lack of recognition but is rather structural ignorance. (shrink)

A few weeks ago, a rural hospital administrator phoned with a question posed by his management team. “If you were going to give us some ethics resources,” he queried, “just exactly what would they...

Hospital ethics committees have evolved as a response to complicated legal, ethical, and social dilemmas that accompany modern medicine. In the United States, their growth has been augmented by Joint Commission for the Accreditation of Healthcare Organizations standards and the Patient Self-Determination Act. There appears to be an implicit presumption that all clinical ethics consultation practices are relatively similar. Finally, there is heightened awareness of the needs for quality standards and assessment of the outcomes of ethics consultations.

Clinical research is increasingly conducted in settings that include private physicians’ offices, clinics, community hospitals, local institutes, and independent research centers. The migration of such research into this new, non–academic environment has brought new cadres of researchers into the clinical research enterprise and also broadened the pool of potential research participants. Regulatory approaches for protecting human subjects who participate in research have also evolved. Some institutions retain their own Institutional Review Boards (IRBs), but Independent IRBs, community hospital IRBs and community–based (...) IRBs also fulfill oversight responsibilities. This article sheds light on this evolving world by discussing the findings gleaned from two studies: a study of the decision making processes used by members who serve on different kinds of IRBs and a study of the decision making processes employed by research participants. The article then discusses how the key findings may inform proposed revisions to the Common Rule. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Graffiti and Colonial Unknowing:A Comment on Mishuana Goeman's "Caring for Landscapes of Justice in Perilous Settler Environments"Anna Cookin "caring for landscapes of justice in Perilous Settler Environments," Dr. Goeman shows how the NDN Collective's initiatives, Chemehuevi photographer Cara Romero's Tongvaland project, and the works of Gabrieliño Tongva artist Mercedes Dorame "exemplify communities of care" that work toward "the unmapping of settler terrains" ("Caring for Landscapes" 51). Her address highlights (...) how these cartographic art productions are processes of (re)mapping that challenge colonial spatialities. Drawing on Michi Saagig Nishnaabeg scholar Leanne Betasamosake Simpson's poem "i am graffiti," Goeman frames these art works as Indigenous graffiti, insofar as they are everyday acts of resurgence1 that resist erasure and enact rematriation.My comments aim to articulate how Romero's and Dorame's works both reveal and disrupt a colonial unknowing by showing the cracks of settler colonial spatiality. I take Goeman's address to illustrate that the changing of minds and unsettling of settler identity will not occur through argumentation, facts, and figures alone, but rather through aesthetic and cartographic practices that "provide a way of seeing Indigenous futurities and relationalities" ("Caring for Landscapes" 52).Maps as Tools of Settler ColonialismIn order to highlight how these art practices enact a kind of (re)mapping that breaks through the veneer of colonial permanence, we first need to consider the way mapping transforms land into property in the service of Indigenous erasure and land dispossession. In her address, Goeman offers a short history of what is now called Los Angeles through the lens of dispossession that occurs through "international claiming of property and burgeoning US property law" ("Caring for Landscapes" 53). Tovaangar was divided into Spanish (and [End Page 64] then Mexican) land grants that, after 1846, were "registered under the US as property" (Goeman, "Caring for Landscapes" 53; emphasis added). The Land Act of 1851 "established the domestication of the California landscape under US governance" by legitimating existing Mexican land rights and mapping out territory yet "unclaimed" ("Caring for Landscapes" 54). The mapping of this so-called "unclaimed" territory propelled a violent erasure of California Indians by "establishing new and ongoing commerce centers" ("Caring for Landscapes" 53). Land was transferred into property—as a thing owned—without "the consent of those who … lived on the land since time immemorial, following the settler structure of passing land between Christian nations" ("Caring for Landscapes" 53). By showing how property rights legitimate conquest and violence, Goeman illustrates how mapping has been (and continues to be) an "essential settler-colonial tool to domesticate land in Southern California and propel development" ("Caring for Landscapes" 54). While she demonstrates how the mapping of Tovaangar using 493 hand-drawn Diseños maps served to sever Indigenous communities (and their relationships with land, such as the Gabrieliño Tongva with the San Gabriel Mountains), she emphasizes that this is an ongoing process that has not been left in a distant past. Newer maps that may seem more objective and scientific with "better models of scale or a more realist representation" remain, at their core, maps of dispossession ("Caring for Landscapes" 54).The very desire to objectively determine location by assigning latitude and longitude reveals a colonial spatiality, which "territorialize[s] the physical landscape by manufacturing categories and separating land from people" and conceives of space in terms of property logics (Goeman, "[Re]Mapping Indigenous Presence" 296). In addition to Indigenous land dispossession, this colonial spatiality rejects relationality by creating dualist boundaries between human and non-human, in which land is the raw material for human development and the creation of culture. Cherokee philosopher Brian Burkhart speaks of relationality in terms of locality, which he defines as "being-fromthe-land, knowing-from-the-land, and meaning-from-the-land" (Indigenizing Philosophy xvii). The severing of locality can be understood in terms of the transformation of land as relative to inert matter to be acted upon. Mapping serves as a tool of settler colonial erasure insofar as it delocalizes "land as the relational ground of kinship" into "land as a mere object that only has meaning or value in relation to people" ("Indigenizing Philosophy... (shrink)

In a global era of apology and reconciliation, Canadians, like their counterparts in other settler nations, face a moral and ethical dilemma that stems from an unsavoury colonial past. Canadians grew up believing that the history of their country is a story of the cooperative venture between people who came from elsewhere to make a better life and those who were already here, who welcomed and embraced them, aside from a few bad white men.on 11 June 2008, the Prime Minister (...) of Canada Stephen Harper made a Statement of Apology on behalf of the Canadian government for the Indian Residential Schools system : “The government now recognizes that the consequences of the Indian Residential... (shrink)

Over the past 20 years, clinical research has migrated from academic medical centers to community-based settings, including rural settings. This evolving research environment may present some moral hazards or challenges that could undermine traditionally accepted standards for the protection of human subjects. The study described in this article was designed to explore the influence of motives driving the decisions to conduct clinical trial research in rural community settings. The researchers conducted semi-structured interviews with 80 participants who conducted clinical trials with (...) rural subjects. The interviews provided a way to examine the influence of budgetary factors when deciding to conduct a clinical study, how information about the budget and the purpose of the study is conveyed to research participants, and the potential willingness of clinicians and coordinators to enroll in the kinds of studies they offer. The findings suggest that clinical trial research in rural communities may challenge clinicians’ abilities to balance the needs of the patient with the needs of the research enterprise. Few respondents seemed to recognize the traditionally recognized hazards of a dual relationship, specifically the moral risks of trying to attend to the interests of both patient and industry. It seems important to re-examine how we protect human subjects and what such protection should look like as research becomes part of the way medical care is provided, even in very rural areas. (shrink)

in canada, after the publication of the Truth and Reconciliation Commission’s final report on the Indian Residential Schools, universities and town halls have been flooded with questions about how they are going to implement its ninety-four calls to action and how they are going to promote reconciliation on stolen lands.1 Many universities have taken heed of the call to “Indigenize” their curricula.2 The worry remains, however, that the language of reconciliation is empty rhetoric that “metaphorizes” decolonization, rather than responding to (...) the demands of Indigenous communities for self-determination and land back. For example, we might be wary of the Canadian government’s language of... (shrink)

Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.