How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making.
he problems of abused and neglected children are ep-idemic in our society (U.S. Advisory Board on Child Abuse and Neglect [ABCAN], 1995) and create issues that psychologists may be called on to address. According to ABCAN, conservative estimates indicate that almost 2,000 infants and young children, or 5 children every day, die from abuse and neglect by parents or caretakers each year. Mc-Clain's (ABCAN, 1995; McClain, Sacks, & Frohlke, 1993) research at the Centers for Disease Control and Prevention (CDC) suggests that abuse and neglect kill 5.4 out of every 100,000 children ages four and under.According to ABCAN, fatalities are not the entire story. There are tens of thousands of victims overwhelmed
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