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

General Problems of Consent. Although the requirements for consent
are less clear-cut in practice as compared with research, many observers
of medical settings agree that informed consent is largely a fiction.
Patients commonly sign consent forms without either reading them or
receiving any reasonable explanations as to what their consent involves.
Physicians and other health professionals frequently proceed in their
work as if no explanations are necessary and as if it would be presumptuous
for patients to question their judgment. Most patients are
relatively docile and infrequently challenge these modes of behavior
even when they are concerned about them.
These attitudes are so
characteristic of medical practice that it is highly unlikely that
they can be successfully regulated without major and costly dislocations
of practice patterns. While the threat of malpractice litigation may
serve as a partial deterrent, it probably affects the forms of behavior
(such as obtaining a signed consent) more than their substance (insuring
that the patient really understands). A focused approach on improving
procedures for obtaining surgical consent would be feasible.
Surgical
consent is the area of largest risk of serious violation and one in
which special protections are essential because of the patient's inability
to protect his own interests during the procedure.
VI. Approaches to Accountability for Health Professionals
and Institutions in Respect to Ethical Issues
As I have illustrated in this paper, the delivery of health care
involves a myriad of ethical issues that arise from global health policy
decisions as well as behavior at the level of survice delivery. Because
these issues arise out of conflicts in values or resource limitations,
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