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Fred Rosner, MD
Mount Sinai School of Medicine New York, NY

JAMA. 1995;274(8):609-610.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—A recent Editorial¹ in JAMA criticizes the American Medical Association Council on Ethical and Judicial Affairs report, "Ethical Issues in Managed Care,"² for failing to come to terms with the inherent tension between caring for patients and the physician's role in resource allocation.

Most people underestimate the magnitude of the conflict between a physician functioning under traditional medical ethics and the same physician functioning under a managed care system. Dr Pellegrino emphasizes the irreducibility of conflict between cost-driven, as opposed to care-driven, health care policy. "Delays in care, postponement of consultation or hospitalization... impersonality, loss of dignity, and magnification of suffering... influence the quality of care, degree of satisfaction, and functional capacity of the ill,"³ but are not easily resolvable issues under a managed care system. These are the care issues and cannot be ignored in a cost-controlled system.

No one disputes that ethical . . . [Full Text PDF of this Article]

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