July 24, 1995

Managed Care and Managed Death-Reply

Author Affiliations

Washington, DC

Arch Intern Med. 1995;155(14):1553. doi:10.1001/archinte.1995.00430140133016

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In reply  The term management has multiple meanings when used in a medical context. Because of this, it is La Puma who has it mostly right, but also has it wrong. The term management can be synonymous with treatment, as in the phrase, "the management of congestive heart failure." It is certainly a moral duty for physicians to treat diseases and symptoms and to manage illness in this sense (sense1), even when patients are dying. However, that is not the sense in which I used the term. I supplied a specific definition referring to the use of social and technological mechanisms to control, manipulate, and cajole (sense2). The term managed care refers to this second sense of management. It refers to the use of bureaucratic structures to control and organize the behaviors of physicians and patients, largely on an economic basis. Managed death refers to the use of

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