Abstract
In an insightful exchange on the topic of managed care and conflicts of interest, Robert Sade (2002) and Baruch Brody (2002) differ on whether it is appropriate for physicians to practice under incentive structures that compromise a physician’s loyalty to each individual patient. Sade, a current member of the American Medical Association’s Council on Ethical and Judicial Affairs (CEJA), argues in favor of the kinds of traditional fiduciary obligations and medical mores emphasized in a CEJA report on managed care (1995). Brody argues against them. Their exchange captures nearly all of the issues prominent in current debate on managed care, and thus provides the ideal opportunity to consider the strengths and weaknesses of each side and work out the general rubric for a mediating position. However, while I avail myself of the opportunity to consider the merit of each side in the debate, I am not a mediator. Instead, I seek to place their arguments in a broader context, and suggest that despite their divergent positions, Brody and Sade share many assumptions. I’d like to call these into question, and thereby reframe the debate.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Angell, M. (1987) ‘Medicine: the endangered patient-centered ethic.’ Hastings Center Report 17, 12–13.
Beauchamp, D. Steinbock, B. (Eds.) (1999). New Ethics for the Public’s Health. New York: Oxford University Press.
Brody, B. (2002). ‘The AMA’s position on managed care.’ In: W. Bondeson and J. Jones (Eds.), The Ethics of Managed Care: Professional Integrity and Patient Rights (pp. 41–53 ). Dordrecht: Kluwer Academic Publishers.
Buchanan, A. (2000). ‘Trust in managed care organization.’ Kennedy Institute of Ethics Journal 10, 189212.
Cassell, E. (1995). The Healer’s Art. Cambridge, Massachusetts: The MIT Press.
Cribb, A. (2001) ‘Reconfiguring professional ethics: The rise of managerialism and public health in the UK National Health Service.’ HEC Forum 13, 111–124.
Council on Ethical and Judicial Affairs (1995). ‘Ethical issues in managed care.’ Journal of the American Medical Association 273, 330–335.
Eddy, D. (1996) Clinical Decision Making: From Theory to Practice. Salbury, Massachusetts: Jones and Bartlett Publishers.
Epstein, R. (1999) ‘Managed care under siege,’ Journal of Medicine and Philosophy 24, 434–460.
Flexner, A. (1910). Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. New York: The Carnegie Foundation for the Advancement of Teaching.
Goodman, J. and Musgrave, G. (1992) Patient Power: Solving America’s Health Care Crisis. Washington, DC: Cato Institute.
Institute of Medicine (2001). Crossing the Quality Chasm: A New Health System for the 21s’ Century. National Academy Press.
Kendig, D. (1997). Purchasing Population Health: Paying for the Results. Ann Arbor: University of Michigan Press.
Khushf, G. (2000). ‘Organizational ethics and the medical professional: Reappraising roles and responsibilities.’ In: D. Thomasma and J.L. Kissell (Eds.), The Health Care Professional as Friend and Healer (pp. 148–162 ). Washington, DC: Georgetown University Press.
Khushf, G. (2001). ‘What is at issue in the debate about concepts of health and disease? Framing the problem of demarcation for a post-Positivist era of medicine.’ In L. Nordenfelt (Ed.), Health, Science and Ordinary Language (pp. 123–170 ). Amsterdam/New York: Rodopi Press.
Khushf, G. and Gifford, R. (1998) ‘Understanding, assessing, and managing conflicts of interest.’ In: L. Mccullough, J. Jones, and B. Brody (Eds.), Surgical Ethics. New York: Oxford University Press.
Kohn, LT, et al. (eds.) (2000). To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press.
Leder, D. (Ed.) (1992). The Body in Medical Thought and Practice. Dordrecht: Kluwer Academic Publishers.
Morreim, H. (1995) Balancing Act: The New Medical Ethics of Medicine’s New Economics. Washington, DC: Georgetown University Press.
Pellegrino, E. and Thomasma, D. (1981). A Philosophical Basis of Medical Practice: Toward a Philosophy and Ethic of the Healing Professions. New York: Oxford University Press.
Rodwin, M. (1993) Medicine, Money and Morals: Physicians’ Conflicts of Interest. New York: Oxford University Press.
Sade, R. (2002). ‘Medicine and managed care, morals and markets.’ In: W. Bondeson and J. Jones (Eds.), The Ethics of Managed Care: Professional Integrity and Patient Rights (pp. 55–72 ). Dordrecht: Kluwer Academic Publishers.
Shortell, S., et al. (1998). ‘Physicians as double agents: Maintaining trust in an era of multiple accountabilities.’ Journal of the American Medical Association 280 (12), 1102–1108.
Spece, R., Shimin, D. Buchanan, A. (eds.) (1995). Conflicts of Interest in Clinical Practice and Research. New York: Oxford University Press.
Peppin, J. (1999) ‘Business ethics and health care: The reemerging institution-patient relationship.’ Journal of Medicine and Philosophy 24, 535–550.
Zoloth, L. (1999). ‘The best laid plans: Resistant community and the intrepid vision in the history of managed care.’ Journal of Medicine and Philosophy 24, 461–491.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2002 Springer Science+Business Media Dordrecht
About this chapter
Cite this chapter
Khushf, G. (2002). A Radical Challenge to the Traditional Conception of Medicine: On the Need to Move Beyond Economic Factors When Considering the Ethics of Managed Care. In: Bondeson, W.B., Jones, J.W. (eds) The Ethics of Managed Care: Professional Integrity and Patient Rights. Philosophy and Medicine, vol 76. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-0413-7_6
Download citation
DOI: https://doi.org/10.1007/978-94-017-0413-7_6
Publisher Name: Springer, Dordrecht
Print ISBN: 978-90-481-6185-0
Online ISBN: 978-94-017-0413-7
eBook Packages: Springer Book Archive