I came across a case and commentary article in the AMA Journal of Ethics about what should be done in the event of a hospital closure. In it the authors present a case about the imminent closure of a rural hospital and its impact on the community. The issue of hospital closures in rural areas has been a hot topic for some time now. The number of closures has nearly doubled in recent years. With the rising cost of doing business in the health care arena, the lack of stable financial support makes rural hospitals more vulnerable than their urban counterparts. The obvious outcomes related to rural hospital closures include the economic impact for communities and decreased access to care for the residents. However, the decision as to whether or not a rural hospital remains open should not only be determined by economic variables, but the long-term ramifications of such decisions must be examined through an emotional lens as well.

Rural hospitals have a significant impact on the viability of the community. Because rural hospitals tend to be large employers in rural communities, their absence not only means less availability of jobs, but also has a profound effect on the local economy.

Access to care in rural communities is usually in the form of Federally Qualified Health Centers (FQHCs), rural health clinics and acute care hospitals. According to a 2017 brief published by NC Rural Health Research Program, a significant portion of Americans, more than 600,000 individuals, lived in counties without any of those services available thus leaving them with the choices of having to travel great distances to receive care or to do without. This exacerbates the disparities experienced by rural populations that tend to be older and have more health issues.

Finally, there’s the emotional impact of rural hospital closures. Patients develop a relationship with their health care providers. Their doctors know their history and understand their idiosyncrasies. When local health care options are no longer available to people it can bring about feelings of uncertainty and insecurity as to what to do should a medical need arise.

Decision makers have an ethical responsibility to ensure that the needs of the community are taken into consideration when determining the fate of rural hospitals. The best way to accomplish this is to include the community in the conversation and let the decisions be informed by their input. And if closure becomes ultimately necessary, there should be a plan to assist the community in the transition.