Is ethics for sale?... Juggling law and ethics in managed care.

INTRODUCTION The need for fundamental changes within the healthcare arena has long been recognized and accepted. However, the debate as to the role that managed care should play in determining patient treatment and the interplay between ethics, law and the managed care of patients, remains the subject of persistent and intense debate. Corporate business practices, including cost-containment, are antithetical to the traditional medical ethics that are the framework of the medical profession, and the ever-encroaching corporate culture is on a dangerous collision course with both medical ethics and the legal tenets that have offered it support. This Note will address the various facets of medical and legal ethics in the courts and health care system. It will be divided into three major sections. Sections II will provide a brief overview of the basic principles of medical ethics and their common applications in the managed care setting. Attention will be given to an overview of relevant, ethical guidelines that are instructive in the context of managed care decision-making. These sections will also identify and analyze ethical issues raised by key court cases, outline collaborative and practical attempts to improve fairness in coverage decisions within managed care as a starting point for discussions on ethics in managed care, and will discuss the issue of resource allocation and ethics in managed care including ideas and principles identified in the newly released 2004 Institute of Medicine report, Insuring America's Heath: Principles and Recommendations. Section III will also evaluate professional obligations, recent problems based on the complex relationship of medical directors to contract law, and the application of various codes of ethics to these circumstances to illustrate intersection between medical ethics and legal ethics in managed care. Specifically, the section will provide a brief overview of the traditional obligations inherent in the physician-patient relationship, examine the interplay between contract law and ethics, and evaluate the concept of the Plan as a contract. Attention will then turn to an overview of the conflict between the physician's fiduciary duty to the patient, and his/her fiscal responsibility to the managed care organization (MCO), particularly the DEPAUL JOURNAL OF HEALTH CARE LAW physician's professional obligations and contractual responsibilities within the managed care environment. This section will conclude with a brief discussion of the efforts by organized medicine to meet the challenges of the physician's competing obligations both within the boundaries of the managed care contract and within the ethical …