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May 02, 2006

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Amy Tuteur

There's just one really significant problem: P4P is unethical. As I wrote on my own blog, Treat Me With Respect:

"The fundamental relationship in medicine is the doctor-patient relationship. Society and the law recognize this by privileging this relationship in comparison to other types of relationship. The doctor has a MORAL and and legal obligation to put the patient's interests and well-being above his own. Obviously, not every doctor will do that. There are some doctors who might recommend expensive treatments purely to enrich themselves. However, we understand those doctors to be unethical, and they may even be subject to legal action.

In dramatic contrast, however, P4P attempts to inject the insurer into the relationship. Even more objectionable, the insurer asks the doctor explicitly to balance the patient's interests against the doctor's financial interest. This is fundamentally unethical and should be banned as a result...

[T]he sanctity of the doctor patient relationship is a moral right. Insurers are not free to violate it simply because it may free up money to care for others (or more likely to profit the insurance company). Furthermore, it is UNETHICAL for an insurance company to ask doctors to violate this patient right.

Doctors should stand firm on this important point. We should refuse to participate in any system that is unethical on its face and we should aggressively charge the industry with their ethical violations."

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