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August 23, 1995

Managed Care: Ethical Issues-Reply

Author Affiliations

Agency for Health Care Policy and Research Rockville, Md
Michigan State University East Lansing

JAMA. 1995;274(8):611. doi:10.1001/jama.1995.03530080025030

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In Reply.  —We agree with Dr Rosner that today's managed care environment poses a number of challenges to the ethics of the physician-patient relationship. We disagree with his diagnosis that the problem lies with the very concept of managed care, rather than how it is implemented.The letter captures a sense of "traditional" medical ethics with the statement, "The ethics of medical care should be totally divorced from the costs of rendering that care," a goal the author acknowledges as impractical. We argue that the flaw with that seductive but ultimately untenable view of medical ethics is as much theoretical as practical—it assumes ethical medical care is that provided in a world in which all resources are infinite; and that means in turn that each physician has infinite time and infinite energy for each patient. "Traditional" medicine was never like that; physicians always spent more time and energy (if not

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