Skip to main content
Journal of Medical Ethics logoLink to Journal of Medical Ethics
. 1991 Mar;17(1):10–18. doi: 10.1136/jme.17.1.10

What future for ethical medical practice in the new National Health Service?

R D Persaud 1
PMCID: PMC1375965  PMID: 2033624

Abstract

The British Government is implementing some major alterations to the way health services in Great Britain are organised. As well as the introduction of competition between health care providers, their financial interests are to be linked to their output, in efforts to use market forces to increase efficiency and cut costs. This paper looks at the possible impact of these changes of health care organisation on ethical medical practice. This is investigated with particular reference to the country whose health service has embraced most closely these elements of the market--the United States of America. The question to be answered is whether high standards of ethical care are ensured by factors somehow intrinsic to the medical profession, and are therefore immune to changes in the economics of health care. This assumption is shown to be questionable in light of what is known about the determinants of ethical medical practice.

Full text

PDF
10

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander E., Jr Ethics corner--can medical ethics be taught? Surg Neurol. 1988 May;29(5):422–423. doi: 10.1016/0090-3019(88)90057-2. [DOI] [PubMed] [Google Scholar]
  2. Berrien R. The changing climate of medical practice. What future for primary care private practice? N Engl J Med. 1987 Feb 5;316(6):334–337. doi: 10.1056/NEJM198702053160610. [DOI] [PubMed] [Google Scholar]
  3. Blendon R. J. The public's view of the future of health care. JAMA. 1988 Jun 24;259(24):3587–3593. [PubMed] [Google Scholar]
  4. Cohodes D. R. America: the home of the free, the land of the uninsured. Inquiry. 1986 Fall;23(3):227–235. [PubMed] [Google Scholar]
  5. Colloton J. W. Academic medicine's changing covenant with society. Acad Med. 1989 Feb;64(2):55–60. doi: 10.1097/00001888-198902000-00001. [DOI] [PubMed] [Google Scholar]
  6. Dougherty C. J. Cost containment, DRGs, and the ethics of health care. Ethical perspectives on prospective payment. Hastings Cent Rep. 1989 Jan-Feb;19(1):5–11. [PubMed] [Google Scholar]
  7. Etheredge L. Ethics and the new insurance market. Inquiry. 1986 Fall;23(3):308–315. [PubMed] [Google Scholar]
  8. Forrest J. V., Lasser E. C. Beer company more ethical than medical community? Radiology. 1988 Mar;166(3):901–901. doi: 10.1148/radiology.166.3.3340796. [DOI] [PubMed] [Google Scholar]
  9. Freund D. A., Allen K. S. Factors affecting physicians' choice to practice in a fee-for-service setting versus an individual practice association. Med Care. 1985 Jun;23(6):799–808. doi: 10.1097/00005650-198506000-00005. [DOI] [PubMed] [Google Scholar]
  10. Geelhoed G. W. In the healing business to look good. South Med J. 1988 May;81(5):650–650. doi: 10.1097/00007611-198805000-00025. [DOI] [PubMed] [Google Scholar]
  11. Ginzberg E. A hard look at cost containment. N Engl J Med. 1987 Apr 30;316(18):1151–1154. doi: 10.1056/NEJM198704303161811. [DOI] [PubMed] [Google Scholar]
  12. Ginzberg E. The monetarization of medical care. N Engl J Med. 1984 May 3;310(18):1162–1165. doi: 10.1056/NEJM198405033101806. [DOI] [PubMed] [Google Scholar]
  13. Henry M. C., Margulies J. L., Olson C. M. Economic triage: emergency physicians should say "no". Ann Emerg Med. 1986 Aug;15(8):983–984. doi: 10.1016/s0196-0644(86)80714-4. [DOI] [PubMed] [Google Scholar]
  14. Howe K. R. Medical students' evaluations of different levels of medical ethics teaching: implications for curricula. Med Educ. 1987 Jul;21(4):340–349. doi: 10.1111/j.1365-2923.1987.tb00373.x. [DOI] [PubMed] [Google Scholar]
  15. Hyman D. A., Williamson J. V. Fraud and abuse. Setting the limits on physicians' entrepreneurship. N Engl J Med. 1989 May 11;320(19):1275–1278. doi: 10.1056/NEJM198905113201911. [DOI] [PubMed] [Google Scholar]
  16. Jonsen A. R. Leadership in meeting ethical challenges. J Med Educ. 1987 Feb;62(2):95–99. doi: 10.1097/00001888-198702000-00003. [DOI] [PubMed] [Google Scholar]
  17. McKinlay J. B., Arches J. Historical changes in doctoring: a reply to Milton Roemer. Int J Health Serv. 1986;16(3):473–477. [PubMed] [Google Scholar]
  18. Miller G. D., Frank D., Franks R. D., Getto C. J. Noncognitive criteria for assessing students in North American medical schools. Acad Med. 1989 Jan;64(1):42–45. doi: 10.1097/00001888-198901000-00016. [DOI] [PubMed] [Google Scholar]
  19. Novack D. H., Detering B. J., Arnold R., Forrow L., Ladinsky M., Pezzullo J. C. Physicians' attitudes toward using deception to resolve difficult ethical problems. JAMA. 1989 May 26;261(20):2980–2985. [PubMed] [Google Scholar]
  20. Perkins H. S., Saathoff B. S. Impact of medical ethics consultations on physicians: an exploratory study. Am J Med. 1988 Dec;85(6):761–765. doi: 10.1016/s0002-9343(88)80017-2. [DOI] [PubMed] [Google Scholar]
  21. Povar G., Moreno J. Hippocrates and the health maintenance organization. A discussion of ethical issues. Ann Intern Med. 1988 Sep 1;109(5):419–424. doi: 10.7326/0003-4819-109-5-419. [DOI] [PubMed] [Google Scholar]
  22. Relman A. S. Dealing with conflicts of interest. N Engl J Med. 1985 Sep 19;313(12):749–751. doi: 10.1056/NEJM198509193131209. [DOI] [PubMed] [Google Scholar]
  23. Relman A. S. The allocation of medical resources by physicians. J Med Educ. 1980 Feb;55(2):99–104. doi: 10.1097/00001888-198002000-00002. [DOI] [PubMed] [Google Scholar]
  24. Rice T. H., Labelle R. J. Do physicians induce demand for medical services? J Health Polit Policy Law. 1989 Fall;14(3):587–600. doi: 10.1215/03616878-14-3-587. [DOI] [PubMed] [Google Scholar]
  25. Rodning C. B., Dacso C. C. A physician/advertiser ethos. Am J Med. 1987 Jun;82(6):1209–1212. doi: 10.1016/0002-9343(87)90227-0. [DOI] [PubMed] [Google Scholar]
  26. Ross C. E., Lauritsen J. Public opinion about doctors' pay. Am J Public Health. 1985 Jun;75(6):668–670. doi: 10.2105/ajph.75.6.668. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Royce P. C., McCutcheon M. L. Medical ethics. J Med Educ. 1987 Jul;62(7):619–619. doi: 10.1097/00001888-198707000-00013. [DOI] [PubMed] [Google Scholar]
  28. Siu A. L., Sonnenberg F. A., Manning W. G., Goldberg G. A., Bloomfield E. S., Newhouse J. P., Brook R. H. Inappropriate use of hospitals in a randomized trial of health insurance plans. N Engl J Med. 1986 Nov 13;315(20):1259–1266. doi: 10.1056/NEJM198611133152005. [DOI] [PubMed] [Google Scholar]
  29. Sohl P., Bassford H. A. Codes of medical ethics: traditional foundations and contemporary practice. Soc Sci Med. 1986;22(11):1175–1179. doi: 10.1016/0277-9536(86)90184-x. [DOI] [PubMed] [Google Scholar]
  30. Spooner C. E., Jr On the importance of ethics. J Med Educ. 1988 Apr;63(4):339–340. doi: 10.1097/00001888-198804000-00016. [DOI] [PubMed] [Google Scholar]
  31. Thompson I. E. Fundamental ethical principles in health care. Br Med J (Clin Res Ed) 1987 Dec 5;295(6611):1461–1465. doi: 10.1136/bmj.295.6611.1461. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Wortis J. Conflicts of interest. Biol Psychiatry. 1988 Feb 1;23(3):215–216. doi: 10.1016/0006-3223(88)90031-5. [DOI] [PubMed] [Google Scholar]
  33. Yuan R. T. Confessions from the bottom. Plast Reconstr Surg. 1988 Feb;81(2):303–304. doi: 10.1097/00006534-198802000-00048. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Medical Ethics are provided here courtesy of BMJ Publishing Group

RESOURCES