Moral Uncertainty in Community Health: Results from Qualitative Interviews with Community Health Center Clinical Leadership

Abstract: Community health centers (CHCs) provide primary care to 30+ million people in America annually and serve people with complex health and social needs, regardless of ability to pay. Although they are at the forefront of advancing health equity for patients adversely impacted by social drivers of health, they have received scant attention in bioethics literature, which tends to focus on hospital “bedside” ethics. This presentation will discuss findings from qualitative interviews with a national sample of CHC clinical leaders. Interviewees were asked about situations, patient cases, or policies that “keep you up at night” and shared instances of when they’ve asked themselves or others “what’s the right thing to do?” Sources of moral uncertainty that emerged from the interviews reflected systemic issues in American healthcare and their unique inflection in the CHC context, including racial disparities in health outcomes and access to medical care, the staffing crisis, provider burnout, healthcare delivery models, and barriers to care. We describe how these issues take on added moral complexity due to community health centers’ mission and role as safety net providers. We also discuss results that point to unexplored normative questions that merit interdisciplinary bioethics research or attention, including which needs or whose needs deserve priority in the primary care setting and how to balance CHCs’ healthcare focus with their mission to address social drivers of health.

Johanna Crane – Albany Medical College