AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. March 2000, Volume 2, Number 3.

Journal Discussion

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Managed Care and End-of-Life Decisions

Readers are referred to an article in a 1998 issue of Archives of Internal Medicine by M.G. Kuczewski abd M. DeVita to consider whether it is possible to provide appropriate end-of-life care to patients within the financial constraints of a managed-care system.

Articles and books on bioethics continue to expand in both number and the range of topics discussed. Between 1989 and 1998, more than 4000 articles alone were published in MEDLINE-cited journals. Some of the major topics examined are the patient-physician relationship, end-of-life care, reproductive medicine, genetics, and the allocation of scarce medical resources. From these publications, we will be selecting a handful of articles and chapters, some of which reflect issues of perennial concern to physicians, others reflect more recent quandries resulting from advances in biomedical technology.

A new article or book chapter will be featured every month, accompanied by questions intended to guide readers along the path of ethical reasoning and to promote discussion.

Kuczewski MG, DeVita M. Managed care and end-of-life decisions. Arch Intern Med. 1998;158:2424-2428.

Questions for Discussion

The financial issues of billing and reimbursement are an unavoidable fact of present healthcare decision making in end-of-life treatment.

  1. Is it possible to provide appropriate care to patients while working within these financial constraints? Explain.
  2. Is the influence of these contraints on decision making necessarily hard-hearted?
  3. How can a healthcare system operate within such a framework and still preserve such virtues as compassion and empathy?
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