Managed behavioral healthcare poses multiple ethical challenges for clinicians

What, then, might characterize an ethical managed behavioral healthcare system, or any behavioral healthcare system for that matter? Using the prior discussion, an ethical system would have as many of the following characteristics as possible: • Power should be balanced between the payor, the management organization, the professional caregiver, and the public/consumer. • While the needs of patients for competent care should remain primary, the needs of society, colleagues, and caregivers should not be neglected. • Competent care should include the use of objectively derived, evidenced-based guidelines when available, allowing for individual variation due to consumer preferences, case complexity, or both. • The structure and processes of the systems should be transparent, including the open sharing of information for implicit and explicit informed consent. • Confidentiality standards should be met and only broken for higher ethical needs, such as endangered lives or actual use of information to improve particular and general outcomes. • Accountability for quality of care should be ensured. • An ethics committee or use of an ethics consultant should be incorporated. It seems clear that managed care has challenged the use and adequacy of traditional healthcare ethics.23 The escalation of the relevance of business ethics, in terms of having a product and being financially successful, often produces dilemmas over how to balance those needs with traditional healthcare concerns. Nevertheless, using the traditional AMA's Principles of Medical Ethics and the commonly accepted biomedical ethical principles as standards, it is indeed possible to use those principles, not only in managed care systems as they exist, but also to guide reform of managed care or, ultimately, produce a better mental system.