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July 24, 1995

Managed Care and Managed Death

Author Affiliations

Chicago, Ill

Arch Intern Med. 1995;155(14):1553. doi:10.1001/archinte.1995.00430140133014

Managed care is a term designed to appeal to executives and administrators. It attempts to integrate a businesslike approach to medicine with the personal attention that patients expect from their doctor. The term tests poorly in focus groups, and some public relations departments are already replacing it with coordinated care and advocate care.

Managed death is a term designed to appeal to a public whose real fear is that physicians will not relieve pain near the end of life. The term managed death implies that control is possible, an idea far preferable to the sinister hiss of assisted suicide and the holocaustic echo of euthanasia.

Sulmasy1 has it mostly right: death is no more manageable than is care. But he also has it wrong: treatment is manageable, even if care is not. Treatment is technical; care is personal, emotional, and psychological. Treatment can be expertly prescribed, timed, quantified, delivered,

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