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October 14, 1996

Ethical Decision Making in Managed Care

Author Affiliations

Departments of Medicine and Pediatrics Albany Medical College A-130 Albany, NY 12208

Arch Intern Med. 1996;156(18):2041-2045. doi:10.1001/archinte.1996.00440170041005

PATIENT-PHYSICIAN decision making is increasingly taking place within the context of managed care. The managed care plan must, because of competition, compel the physician to act as its agent, not the patient's; this puts it in conflict with patient-centered medical ethics. Examination of the meaning of autonomy, however, points the way to a new ethics for managed care. In accord with the principles of liberal democracy, the patient and physician must give up some individual autonomy in return for participation, through their representatives, in determining and applying the rules of the managed care plan. The development of ethical managed care plans can be promoted by government regulation, by liability reform, and by pressure from subscribers.

You are seeing a patient in your office. Her upper respiratory tract infection began 1 week ago. Now she appears to have acute sinusitis. She is getting worse and wants treatment. What antibiotic should you

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