A recent article published in the journal BMC Medical Ethics explores the ethical issues related to geographical variations within the provisioning of health care services, and aims to guide health policy with their findings.

There is sufficient documentation evidencing healthcare needs are greater among lower income populations, yet utilization and access to healthcare is much higher among affluent populations. The geographic distribution of resource allocation and health services utilization were documented as well. Demographic differences and epidemiological terms most often do not explain these variations, and instead, inequitable access to healthcare services should be looked at as a systemic issue – scaling back to analyze the role of surrounding environments. Looking at the underuse and overuse of healthcare services around the country can help alleviate some of the challenges for clinical practice, health policymaking, and health services provision. Yet, a comprehensive explicit ethical analysis of this topic has yet to be performed, causing problems related to distributive justice, quality of care, and health policy.

Geographical variations in terms of the four bioethical principles of justice, non-maleficence, beneficence, and autonomy are specifically analyzed in the article, and have revealed problems of injustice, harm, lack of beneficence, and paternalism. Simply denoting geographic location does not define better care either, nor does it result in it. The normative problems of defining the goodness of care and drawing a line between good and bad care must be addressed in order to solve the inequitable and varied landscape of healthcare in the U.S. Incorporating GIS and a critical geographic lens are important steps to helping confront the ethical issues that arise within the healthcare industry.