A lawyer and a physician propose a set of compromises designed to address "the realities" of medical practice under managed care [1]. Although these are couched in terms of pro-patient ethics, hidden among the authors' disclaimers is a compromise so pernicious as to pervert their entire premise (as well as our profession if we accept it). The authors propose to replace the principle of devotion to the individual under our care with the best interests of the "group" of patients under our care. This distinction may be casual to the authors, but dedication to an individual patient is the defining relationship of our profession; our first concern must be for this individual, not the group. We could well ask Mr. Hall to do what is best for the "group" in a trial rather than attend his client's interests. Where the interests conflict, as they do in this day of limited resources, the group must be subordinate to the individual. We should also ask, "Who limits these resources, and why should we modify our ethics to preserve their profits?" No, we must hold to the principle of care for the individual patient, not some misguided utilitarian belief. Physicians should not capitulate their role as a patient's advocate and agree to do managed care's dirty work.

A physician's role is attending patients, one at a time. Although a secondary role could be to define the most effective ways to provide that care, it is society's responsibility to provide the resources for the citizen's health, not the physician's responsibility to ration them. The surest way to weaken any group is to lessen the value of the individuals in that group. If we succeed in providing optimal care for the group at the expense of the individual, it will be a Pyrrhic victory indeed.