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March 1997

Managed Care and Managed Death

Author Affiliations

London, Ontario

Arch Neurol. 1997;54(3):330. doi:10.1001/archneur.1997.00550150086022

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Managed care and managed death each call forth strong emotions. To suggest a linkage is downright inflammatory. And yet, both are rising. Is the relationship causal, coincidental, or one of common origin?

McQuillen subscribes to the latter theory, arguing that managed care and managed death are the philosophical descendants of utilitarianism, which stands for "the greatest good for the greatest number." He gives examples of individuals, particularly neurologic patients, driven to desperation and death. As he acknowledges, anecdotes are a weak form of evidence, but death and disability by denial are inherent risks in a system explicitly geared toward spending as little as possible.

Menken opts for the coincidence option and dismisses any link between managed care and managed death as "wholly free of empirical evidence." However, absence of proof is no proof of absence. Perhaps this controversy will create interest in evaluating scientifically the impact of managed care on

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