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March 1997

Managed Care and Managed Death: Peas From the Same Pod?

Author Affiliations

From the Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY.

Arch Neurol. 1997;54(3):326-328. doi:10.1001/archneur.1997.00550150082020

Amid a whirlwind of change in medicine today, there is a disturbing concurrence of movements that share a commonality in name and may share common roots. These movements—toward managed care and managed death—are of particular concern to neurologists, whose access to patients is restricted by the former and whose patients are often the focus of the latter (at least in the practice of a self-styled obiatrist, Dr Kevorkian, more than half of whose patients came with neurologic diagnoses1 to be assisted in "finding their deaths"). In a provocative commentary2 on this question, in which he described a plausible scenario of a woman with amyotrophic lateral sclerosis being offered by a harried health maintenance organization gatekeeper pills or a "quick and painless" injection among the various options for dealing with the grim future of that disease, Sulmasy predicted that "managed death, as a means of providing cost-effective managed care,

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