Ethics, Money, and the Problem of Coercion in Managed Behavioral Health Care
![handle is hein.journals/stlulj40 and id is 375 raw text is: ETHICS, MONEY, AND THE PROBLEM OF COERCION IN
MANAGED BEHAVIORAL HEALTH CARE
JOHN PETRILA, J.D., LL.M.
INTRODUCTION
HEALTH care providers have a fiduciary responsibility to act in the best
interests of their patients.' Until recently, physicians could discharge this
ethical obligation with comparative ease: physicians controlled the vast
majority of health care expenditures through their treatment decisions,2 and
traditional reimbursement systems, which rarely questioned professional
judgment, posed little conflict with a physician's definition of patient best
interest.3
There have been at least two major challenges to this professional
hegemony in recent years. First, patients have become consumers of
health care services; supported by expanding legal deference to patient
autonomy, the balance of power in the physician-patient relationship has
* Mr. Petrila is Chair of the Department of Mental Health Law and Policy at the Florida
Mental Health Institute, University of South Florida. He holds a joint appointment as Professor
in the College of Public Health and is an Adjunct Professor of Law at Stetson University College
of Law. The author thanks Alexis Saunders, Lori Tomaselli, and Suzanne Furman for their
invaluable research assistance in the preparation of this article.
1. According to the American Medical Association's Code of Ethics, (a] physician has a
duty to do all that he or she can for the benefit of the individual patient. COUNCIL ON ETHICAL
& JUD. AFF., AM. MED. ASS'N, CODE OF MEDICAL ETHICS 3, Op. 2.03 (1002). The Code also
notes that if the economic interests of the hospital are in conflict with patient welfare, (then]
patient welfare takes priority. Id. at 34, Op. 4.04. See also Council on Ethical & Jud. Aff., Am.
Med. Ass'n, Issues in Health Care System Reform: The Provision of Adequate Health Care, 272
JAMA 1056 (1994) (hereinafter Issues in Health Care].
2. Physicians, through testing and treatment decisions, control approximately 80% of health
care expenditures. E. Haavi Morreim, Economic Disclosure and Economic Advocacy: New
Duties in the Medical Standard of Care, 12 J. LEGAL MED. 275, 278 (1991).
3. See infra notes 42-43 and accompanying text.
4. The doctrine of informed consent, resting on the patient autonomy principle, most
obviously demonstrates the shifting of the balance of power between the health care professional
and the patient. See Schloendorfv. Society of N.Y. Hosp., 105 N.E. 92, 93 (N.Y. 1914) (stating
[e]very human being of adult years and sound mind has a right to determine what shall be done
with his body). The principle of autonomy in making health care decisions, with the right to
privacy, has resulted in an incremental expansion of patient choice control. Gradually this](ViewImageLocal?handle=hein.journals/stlulj40&div=28&collection=journals&method=preview&ext=.png&size=3)
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Ethics, Money, and the Problem of Coercion in Managed Behavioral Health Care
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