Managing the ethics of managed healthcare: A systemic approach

In this article, we argue that traditional clinical ethics, with its dyadic focus on the clinician and patient, is insufficient to deal with the managed healthcare environment. A multilateral, systemic approach identifies the major stakeholders in ethical decisions and embraces the legitimate values of all stakeholders, while at the same time acknowledging their inevitable values, tensions, and ethical blind spots. In this collaborative model, the clinician advocates for the patient and family but also acknowledges the legitimacy of other competing interests and values in healthcare decisions. 1996