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The article presents a discussion on the development of legally mandated patient consent procedures in the formalization of the doctor-patient relationship. It addresses the limitations of law to transform the nature of social transactions between doctors and patients. It is based on the studies conducted to determine the effects of the law passed in Hawaii which require all physicians treating breast cancer patients to present a standardized patient education form about alternative treatment. The law increases the patient's role in the decision making process.

The article discusses the recommendations for more effective health care in the state of Hawaii. Health care services can help to protect ethnic groups in Hawaii from disease and to reduce the negative effects of illness. Native Hawaiians suffer disproportionately from the most significant chronic diseases which underlie disability and mortality in later life, such as diabetes, heart disease, hypertension, and cancer. The pursuit of better health necessitates social changes which would improve the life situation of the Native Hawaiian. In this sense, any steps taken to empower this group, to increase the level of self-efficacy, and to improve their economic situation, must be regarded as important to the promotion of health.

The article features a discussion on hypertension and heart disease in the state of Hawaii. Mortality statistics show that in the early twentieth century, heart disease was insignificant in Hawaii as a cause of death compared to infectious diseases for all ethnic groups. Native Hawaiians have significantly higher rates of heart disease than other ethnic groups. In 1920 the mortality rate from arteriosclerotic disease among Native Hawaiians was 3.4 per 100,000 population, but by 1960 it was 287.2 per 100,000, twice as high as the combined rate for other racial groups.

The article features a framework for assessing the health needs of Hawaiians. Systematic medical information on the population of Hawaii is available since the early 20th century. A report from the US Office of Technology Assessment in 1987 showed that the overall death rate of Native Hawaiians is 34% higher than for the total US population, with higher rates for diseases of the heart, cancer, cerebrovascular disease, and diabetes mellitus. Thus, epidemiological data provide clear evidence that Native Hawaiians are a high risk population for many serious health problems.