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

difficulty in evaluating their feelings of dissatisfaction. A clear
statement of standards in relation to frequently occurring situations,
such as surgical consent, autopsy consent, and research participation,
gives patients clear expectations and a realistic framework to evaluate
their experiences. A clear statement of standards also provides criteria
by which outside groups can document failure in institutional operations
or, if necessary, use as grounds for initiating litigation.
VII. Implementation
Throughout this discussion, I have been skeptical of the rule-making
process and the tendency to respond to each new problem with new regulations.
In addition to being a costly process it encourages skepticism and at
times contempt from those whose behavior the regulation is intended to
influence. Frequently, more modest efforts, better fitted to the realities
of organizational behavior, are more successful in achieving a sensitive
response to the needs and interests of patients and research subjects than
more specific rules and requirements for affirmation of conformity with
these rules.
Throughout the discussion I have indicated that the crux of the difficulty
is the inequalities between patients and providers, and that such
inequalities are greatest when the patient has no choice of providers.
This is often the case in particular DHEW programs, but true in the private
sector as well when geography or the nature of the programs results in
only one source of care.
Whatever the value of intervention, I see little possibility of
achieving effective regulation relevant to ethical behavior in programs
in which the government pays fee-for-service providers for the provision
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