Abstract

Standard approaches to the ethics of managed care fail to capture the complexity of the phenomenon. In particular, the view that managed care aligns with the business side of a fundamental dichotomy between medicine and business is an obstacle to nuanced analysis and to the construction of an ethic that addresses organizations. A version of pragmatism derived from the work of John Dewey is one basis for a more adequate analysis of the ethics of managed care: a method of inquiry oriented to practice, a compelling social vision of democracy and community, a moral psychology built around a holistic concept of individual character, and an appreciation of the importance of organizations as agencies of character formation. Dewey's concept of character can also be applied to organizations, capturing the total complex of formal and informal structures in their internal relations, and in their relations with the external environment. Deweyan pragmatism provides the tools for an analysis of organizational virtues and an evaluation of organizational structures. This analysis is completed in a case study or "character study" of the way in which virtues are displayed and structures are fitted together in the life of a managed care organization, Kaiser Permanente. Kaiser is not free of ethical problems, but it illustrates some of the ways in which some forms of managed care might improve health and health care and contribute to the development of democracy and community