Although managed care per se might be regarded as ethically neutral, it does confront the profession with increased levels of ethical risk. Increased vigilance is necessary in order to avoid the ethical compromises associated with maintaining different standards of care for patients on different payment systems, passing the costs of bad business decisions on to patients, and failing to fully disclose pertinent information to patients, for example. The most serious of the ethical risks to which managed care exposes the profession concerns autonomy of the patient, the dentists, and to some extent the purchaser. Autonomy encompasses individuals' free choice of their own futures, subject to not causing harm to others. It remains to be determined by ethical analysis whether the restructuring of large segments of the health care system based on aggregate patient characteristics is in conflict with the ethical principle of autonomy.
Veracity is also a related ethical risk.
B. It is unethical to participate in care programs that require the dentist to knowingly coerce patients or limit the information available to them for making informed decisions about their care. The dentist-patient relationship is often altered in managed care arrangements, and incidents have been reported of attempts to Justify substandard dentistry based on terms imposed by managed care contracts. At this time there is no conclusive evidence that dental care delivered in managed care settings is different in quality from care delivered in traditional systems. The potential for under treatment represented by selection of care based on coverage rather than need, failure to diagnose, use of inferior materials or performing careless work, rationing access to care, or delegating to unqualified support staff is real. Economic self-interest should not be placed higher than the aspirational goals of compassion, justice, and beneficence.