Between a rock and a hard place: ethics in managed care and the physician-patient relationship

At the heart of ethics in medicine is a solid physician-patient relationship. Managed care has operated to undercut this relationship. Rather than blaming managed care, however, one should identify and modify those social and economic forces that pressure managed care organizations (MCOs) to (1) undercut the physician-patient relationship and (2) engage in other unjust or unethical practices. Identifying these pressures does not let managed care off the hook for unethical practices. In fact, MCOs have both an ethical and a practical obligation to help define and support national health care legislation--to help reinvent their role in health care.