title: Cancer, managed care, and therapeutic research: an ethicist's view.
abstract: The question of whether HMOs should pay for therapeutic oncological research is an important moral question. Simply declaring that a protocol is experimental does not imply that an HMO has no obligation to underwrite the care. On the other hand, the "technological imperative", which states that care should be delivered simply because it is new and technologically advanced is also a false moral premise. HMOs and clinical investigators must both acknowledge that they have competing moral obligations that are sometimes in conflict. They should also accept the formal principle of justice that similars should be treated similarly. If the competing obligations are carefully ranked, it is possible to craft a proposal that meets the criterion of formal justice and simultaneously satisfies all the competing moral obligations. It is suggested that such a proposal would include payment by the HMO for a fraction of care proportionate to the therapeutic motive of the treatment, but that HMOs would also contribute to an all-payer pool to help support therapeutic research. If this, or similar proposals are not considered, the issue will be settled in the courts in a manner that will be detrimental to the nation as a whole.
authors.affiliation: Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC 20007, USA.
authors.forename: D P
authors.initials: DP
authors.lastname: Sulmasy
mesh_terms: D002986:Clinical Trials as Topic / Q000191:economics*; D004991:Ethics, Institutional; D005251:Fees, Medical; D006279:Health Maintenance Organizations / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D008495:Medical Oncology / Q000191:economics*; D028681:Moral Obligations; D009014:Morals; D009369:Neoplasms / Q000628:therapy; D018579:Patient Selection; D012051:Reimbursement Mechanisms; D035842:Research Subjects; D012109:Research Support as Topic / Q000592:standards*; D012935:Social Justice; D036302:Therapeutic Human Experimentation; D014481:United States