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

V. Problems in Service Delivery Relevant to the Ethical
Norms for the Conduct of Research
Dr. Robert Levine in reviewing the legislative history of Paragraph (C)
has found that of the four specific activities noted by the Congress only
one--the sterilization of the Relf sisters--does not fall within the
guidelines concerning research and innovative therapy already considered
by the Commission.
He suggests that the class of behaviors most appropriate
to regulate under Paragraph (C) is practice for the benefit of others
that is not designed solely to enhance the well-being of the individual,
but meets the customary standard for routine and accepted practice (Report
of May 28, p. 11).
A wide range of medical practices potentially fall within the
rubric of "practice for the benefit of others." It is, however, frequently
difficult to determine when the actions taken are intended to
benefit the recipient, his family, or the larger community. Most
commonly, the medical decisions reflect a synthesis of interests. The
physician in making a treatment decision may take into account the patient's
needs, the disruptiveness of his symptoms to the family, economic costs,
and a variety of other factors.
With the new emphasis on family medicine,
doctors are being trained more explicitly to take family and community
contingencies into account in decision making. Although it is probably
futile to deal with this class of practice as a whole, it is prudent to
focus an the ethical problems related to any therapeutic procedures that
are involuntary or coercive.
Such problems exist in the areas of involuntary
commitment to psychiatric institutions, involuntary drug treatment, and
involuntary sterilization. In recent years there has been substantial
1-26