Managed Care: Ethical Issues

Abstract

To the Editor. —A recent Editorial 1 in JAMA criticizes the American Medical Association Council on and Judicial Affairs report, Ethical Issues in Managed Care, 2 for failing to come to terms with the inherent tension between caring for patients and the physician's role in resource allocation. Most people underestimate the magnitude of the conflict between a physician functioning under traditional medical ethics and the same physician functioning under a managed care system. Dr Pellegrino emphasizes the irreducibility of conflict between cost-driven, as opposed to care-driven, health care policy. Delays in care, postponement of consultation or hospitalization... impersonality, loss of dignity, and magnification of suffering... influence the quality of care, degree of satisfaction, and functional capacity of the ill, 3 but are not easily resolvable issues under a managed care system. These are the care issues and cannot be ignored in a cost-controlled system. No one disputes that ethical