Managed Care and the Practice of the Professions

Abstract

We owe Professor Pellegrino (2002) and Professor Boisaubin (2002) a debt of gratitude for bringing to light a number of difficulties faced by the medical profession in addressing the new framework of managed care. I have a great deal of sympathy for much of what they say. In this paper, however, I plan to focus not so much on the specifics they address, as on a more general issue. Managed care introduces new moral quandaries into the profession of medicine -- so much so as to put the profession itself in jeopardy, on Dr. Pellegrino’s account. In this paper I plan to focus primarily on providing a framework for understanding the professions and professional ethics at a high level of generality. I think the framework I will provide helps us to give conceptual shape to the work of Pellegrino and Boisaubin, and also to raise some critical questions about the relationship between the profession of medicine and its institutional structures. These are questions I will raise at the conclusion of the paper.