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Moral Challenges Ahead as Managed Care Marches On

Moral Challenges Ahead as Managed Care Marches On

PHILADELPHIA--Forging ahead with change was the theme of the second
annual meeting of the Association of Cancer Executives (ACE).
And for most of the speakers, change meant adapting to the new
reality of managed care and hospital mergers.

Leonard Fleck, PhD, professor of philosophy and medical ethics,
Michigan State University, took meeting attendees on a tour of
the moral challenges ahead.

He said that when speaking of cutting costs in health care, "one
person's waste and inefficiency is another's life-saving care."
Dr. Fleck gave an example from a Chicago Tribune article, which
described a patient, Mrs. P, who was being treated for a broken
leg. Because the leg was not mending well and would require expensive
additional care, her orthopod called her managed care case manager
for authorization.

The manager asked what would be the cheapest way to treat her.
The physician sarcastically stated that amputation was the least
expensive way, but found he had to furiously back pedal when the
case worker took him seriously, offering an $8,000 payment to
sever the leg. The physician eventually prevailed, spending about
$90,000 in total to save her leg.

Dr. Fleck then turned the question over to the audience of cancer
executives and other health care professionals. He asked participants
to imagine themselves as managed care providers and to vote, via
electronic devices he provided, whether it was a morally defensible
decision to save Mrs. P's leg at such a high cost.

More than half (52%) strongly agreed; 33% agreed; 15% were undecided;
and no one disagreed. In other words, no one in the audience believed
it was right to let managed care providers make such a critical
decision based solely on money, and 85% were certain that saving
the leg was the right decision.

However, when Dr. Fleck recast the scenario, the voting distribution
shifted. If Mrs. P had come into the emergency room with a broken
leg and no insurance, would the hospital trustees be morally justified
in denying her the costly extra treatment needed to save her leg?

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