Ethics in managed care

The current era of managed costs and care create ethical dilemmas based on economic constraints and incorporation of principles of distributive justice. Traditional ethical concerns related to confidentiality, conflicts of interest, double agentry, and honest are complicated by interference in the doctor-patient relationship caused by instructive utilization management. National health reform must take these issues seriously to ensure that the 'cure' promised by such reform efforts is not worse than the disease. The challenge for psychiatrists is to adapt to these constraints without losing site of traditional medical ethical positions. Once the ethics become diseased, no cure may exist at all.