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August 23, 1995

Managed Care: Ethical Issues-Reply

Author Affiliations

Council on Ethical and Judicial Affairs American Medical Association Chicago, Ill

JAMA. 1995;274(8):611. doi:10.1001/jama.1995.03530080025029

In Reply.  —Dr Rosner and Drs Clancy and Brody1 observe that the Council on Ethical and Judicial Affairs failed "to come to terms" in its report with "the inherent tension between caring for individual patients and populations of patients and the physician's role in resource allocation."1 Clancy and Brody further state that the Council "fails to articulate a basic truth" that when physicians use resources for their patients, they are depriving other patients of those resources.1The Council's report directly acknowledged and responded to these concerns. First, the Council observed that, "[w]hen deciding whether to order a test or procedure for a patient," physicians in managed care are expected to "consider whether the slot should be saved for another patient or not used at all to conserve the plan's resources." However, as Rosner points out, this expectation can seriously undermine the physician's traditional role as patient advocate.

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