Appendix to Ethical Guidelines for the Delivery of Health Services by ...

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Recommendations

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Summary of Major Recommendations 1. The Commission should consider the benefits and costs of a requirement that all DHEW direct-service programs and other programs receiving "capacity-building grants from DHEW" establish a Practice Institutional Review Board to have the following functions: A. To establish and monitor a grievance procedure within the program in accord with standards for such a procedure established by DHEW; B. To conduct a continuing review of all "therapeutic actions" within the program taken without the consent of the patient and to insure that these are adequate provisions for review and appeal of such actions; C. To evaluate program practices for obtaining informed consent in therapeutic situations and to make suggestions for improved practice. 2. The Commission should encourage DHEW to develop a program of demonstrations and evaluations of alternative grievance procedures in health care settings and to provide funds for institutional experiments in this area. 3. The Commission should take a strong public position against medical care rationing based on political, sociocultural, or religious criteria. It should publicly support the principle that the medical resources subsidized by DHEW should be distributed to eligible recipients in relationship to medical need and expected medical benefits, and that the scope of services should not be restricted 1-2
on the basis of other criteria. 4. The Commission should sponsor a special study on the violation of civil liberties and other inhumane practices in nursing home care and other types of decentralized health care facilities financed directly or indirectly by DHEW. 1-3
Page 3: APPENDlX TO ETHICAL GUIDELINES FOR
Page 6 and 7: C O N T E N T S (CONTINUED) III. MA
Page 9: 1 ETHICAL PROBLEMS IN THE DELIVERY
Page 14 and 15: I. The Charge This report examines
Page 16 and 17: specific rules and affirmations of
Page 18 and 19: III. Ethical Principles in Service
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Page 22 and 23: physicians to control or sanction o
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Page 26 and 27: Finally, it has been observed that
Page 28 and 29: substantially by the mode of remune
Page 30 and 31: the economic incentives for expensi
Page 32 and 33: well because such facilities are ge
Page 34 and 35: in the patient's care, clear guidel
Page 36 and 37: V. Problems in Service Delivery Rel
Page 38 and 39: examination or request; and that th
Page 40 and 41: General Problems of Consent. Althou
Page 42 and 43: occurs. Moreover, litigation is a h
Page 44 and 45: In implementing a grievance procedu
Page 46 and 47: difficulty in evaluating their feel
Page 48 and 49: suggested in this paper. However, I
Page 50 and 51: 9. David Sudnow, Passing On: The So
Page 53: 2 ON THE RELEVANCE OF ETHICAL PRINC
Page 56 and 57: lines even if the Commission determ
Page 58 and 59: activity was research and, as such,
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4) Sterilization of the Relf Sister
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esearch. In the next section we sha
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expectation of success." Thus, it d
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Yet, something of an analogy may be
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eview proposed activities classifie
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Thus, the standards for the negotia
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"The basis of plans currently opera
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e incomplete. Therefore, I suggest
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equirements. I suggest that the sam
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discussed; ie the NIH requirement f
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perience with drugs where the class
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available for these functions seem
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"...the customary standard for rout
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Some activities conducted in the ca
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15. Report of the International Con
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REPORT TO THE COMMISSION FOR THE PR
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organization were considered, metho
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consulted on specific questions reg
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Section I Research Guidelines The N
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Section IT DHEW Health Programs In
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2. “Capacity building" (8) progra
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Section III Criteria for Applicatio
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The guideline relating to "investig
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address problems germane to the del
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The goal of research is to limit th
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Although health practitioners are p
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Governmental authority, however, is
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Question Number 4: Do the language
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Section V Points for Consideration
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It is also important to note that s
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Footnotes 1. Public Law 93-348. 2.
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The Relevance of Ethical Principles
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the conclusion follows that there i
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There are two types of moral proble
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E. The Right of Equal Access to Hea
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III. THE FUNCTIONS OF ETHICAL PRINC
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the discussion will return to the c
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of patients and physicians. Measuri
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health service programs ought not d
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for choice, without an overriding m
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elevant similarities and difference
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Suppose Congress had asked the ethi
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To return to an unfinished theme of
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to explain political obligations on
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a social-ethical contract that prov
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References 1. Toulmin, S.: Reason i
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22. Aiken, op. cit., p. 162. 23. Go
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ETHICAL ISSUES IN HEALTH CARE Roy B
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Others who have argued that ethical
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Robert Nozick is the leading advoca
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justice is to overcome the results
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a higher level of health care than
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not increase social inequality. The
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(Family Health Centers) and critica
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the fact that in general humans are
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technique to which society would no
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consistent distinction made between
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National Commission for the Protect
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6 ETHICS IN HUMAN EXPERIMENTATION I
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out that in the treatment of the pa
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With regard to special study the Co
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that the study population was not i
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TABLE 1 Gray's study: Awareness of
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In addition to the racial or ethnic
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which were carried out among the Pu
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In a direct comparison between whit
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standards for assuring the protecti
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"Black Doctors Launch Probe of Syph
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7 AMERICAN INDIAN HEALTH CARE DELIV
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absorbed into the system. Contrary
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But exactly the opposite is true. T
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American Indian medical students ha
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1. Public Forum before the Committe
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"IT IS UNFORGIVEABLE THAT IN A COUN
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WRITTEN OR RECORDED INFORMATION, WH
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THESE WRITTEN GUIDELINES AND PROCED
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ISTICS AMONG THIS POPULATION GROUP
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SPANISH SPEAKING PEOPLE LIVE IN DIS
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3-11
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ALTHOUGH LIMITED, DEMOGRAPHIC SOCIA
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THESE ARE VIEWS OF LIFE THAT PEOPLE
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FOLK MEDICINE IS STILL WIDELY PRACT
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WITHOUT SUCH SAFEGUARDS IT IS NOT U
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8-21
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BIBLIOGRAPHY Aalysis of DHEW Health
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6 ETHICS IN HUMAN EXPERIMENTATION I
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out that in the treatment of the pa
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With regard to special study the Co
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that the study population was not i
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TABLE 1 Gray's study: Awareness of
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In addition to the racial or ethnic
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which were carried out among the Pu
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In a direct comparison between whit
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standards for assuring the protecti
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"Black Doctors Launch Probe of Syph
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7 AMERICAN INDIAN HEALTH CARE DELIV
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absorbed into the system. Contrary
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But exactly the opposite is true. T
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American Indian medical students ha
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1. Public Forum before the Committe
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"IT IS UNFORGIVEABLE THAT IN A COUN
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WRITTEN OR RECORDED INFORMATION, WH
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THESE WRITTEN GUIDELINES AND PROCED
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ISTICS AMONG THIS POPULATION GROUP
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SPANISH SPEAKING PEOPLE LIVE IN DIS
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3-11
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ALTHOUGH LIMITED, DEMOGRAPHIC SOCIA
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THESE ARE VIEWS OF LIFE THAT PEOPLE
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FOLK MEDICINE IS STILL WIDELY PRACT
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WITHOUT SUCH SAFEGUARDS IT IS NOT U
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8-21
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BIBLIOGRAPHY Aalysis of DHEW Health
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Resolution and Recommendations of t
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Where patients are treated in teach
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10 AMERICAN HOSPITAL ASSOCIATION ST
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(11) The patient has the right to e
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HEALTH SERVICES ADMINISTRATION Admi
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12 PATIENT'S BILL OF RIGHTS PHOENIX
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2-1.2 12-14-73 may not be able to p
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2-1.2 12-14-73 10. The patient has
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CONDITIONS OF PARTICIPATION MEDICAR
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(12) May meet with, and participate
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14 DEPARTMENT OF HEALTH, EDUCATION,
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and private resources available for
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15-1
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PERSONAL PRIVACY IN AN INFORMATION
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PERSONAL PRIVACY IN AN INFORMATlON
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PERSONAL PRlVACY IN AN INFORMATION
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PERSONAL PRIVACY IN AN INFORMATlON
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Fairness PATIENT ACCESS TO MEDICAL
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Record Keeping in the Medical-Care
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16 DEPARTMENT OF HEALTH, EDUCATION,
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PROPOSED RULES [ 4110-35 ] der seve
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2. SECTION-BY-SECTION ANALYSIS Each
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would allow the attending physican
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or widespread compelling need, and
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PROPOSED RULES either proposed vers
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PROPOSED RULES priate State agency,
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ments of receipt of hysterectomy in
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PROPOSED RULES To the best of my kn
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Comment of the National Commission
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limitation on access to sterilizati
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21 or unable to give informed conse
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form, as drafted, constitutes not o
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many reported deficiencies, such as
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Under the second alternative, a men
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hand, sterilization in anticipation
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