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

specific rules and affirmations of compliance is time taken from other
valued activities, and regulation may be counterproductive in its
consequences. The imposition of any regulation, thus, should be evaluated
not only in terms of its expected symbolic and practical benefits in
changing behavior, reaffirming essential values and reassuring the public,
but also in terms of its real costs in divesting professional energies
and resources from other important activities, discouraging innovation
and creativity through incentives for safe bureaucratic response, and
eroding morale.
Although the identification of problems usually elicits the response
that "there ought to be a rule," such rule making designed to constrain
behavior or to punish violators is negative in its approach and does
little to increase sensitivity or educational dialogue.
Effective guide-
lines in an area as vast and difficult as the one under discussion would
contribute to informing professionals and others as to problems they may
be unaware of and to making them more cognizant of and sensitive to the
strong feelings and views of others.
In short, good regulation contains
a strong educational component. The approach recommended in this paper
is designed to achieve better checks and balances between patient and
provider and through this process greater understanding and sensitivity.
II. Definitions
Section 202 (a)(1)(c) of Public Law 93-348 refers to health services
under programs "conducted or supported by the secretary." This language
covers a wide scope of practice involving much of the private and nonprofit
sectors as well as direct government service programs.
For the purposes
of this discussion, the classification of programs offered by the Health
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