The Ethical Lessons of Managed Care Applied to Clinical Trials

Abstract

With increasing experience there have developed growing concerns with the ethical consequences of managed care. Some of these concerns are with the notion of rationing limited resources while others are with assuring timely appropriate care under the direction of a doctor of the patient’s choosing. The resulting public and professional discussions have illuminated and emphasized the importance of patient rights and of the nature of the relationship between the patient and the health care provider. In this essay I shall try to extract the underlying ethical issues inherent in these concerns. I shall then apply them to another ethically troubling medical technique; the randomized clinical trial. I do this because while the concerns are similar, physician and public response is quite different; medical practitioners and the public are wary of managed care while physicians appear to embrace and the public accepts the use of randomized trials in the context of patient care.