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October 14, 1996

Guidelines, Managed Care, and Ethics

Author Affiliations

Department of Philosophy University of California, Davis 2221 Stockton Blvd, PCC 3107 Sacramento, CA 95817

Arch Intern Med. 1996;156(18):2038-2040. doi:10.1001/archinte.1996.00440170038004

IN THIS ISSUE of the Archives, Berger and Rosner1 discuss the ethics of practice guidelines. They define these as "written statements that describe preferable courses of clinical action, ranges of acceptable medical practice, or required medical response."1 Although written guidelines are of relatively recent vintage, guidelines in themselves are nothing new. Information, ways of thinking, and ultimately guidelines (for thinking and acting) are precisely what has been taught by professional colleges since their existence. Such guidelines also form much of what is discussed at postgraduate sessions. What is new and what is, as the authors rightly point out, ethically problematic is that issues other than quality care have often become the driving force motivating the genesis of such guidelines. The authors fear that "nonmedical values combined with intense pressures on health care provision [may] create an environment for guideline misuse." The authors are well aware that even clinical

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