Responding to the ethical challenges posed by the business tools of managed care in the practice of obstetrics and gynecology.

We provide a preventive ethics approach that equips obstetrician-gynecologists to respond proactively to the ethical challenges posed by the business tools of managed care. This approach is based on an ethical analysis of medicine as a fiduciary profession. This analysis identifies four virtues: self-effacement, self-sacrifice, compassion, and integrity. We show how these four virtues can be applied proactively in response to conflicts of interest in how physicians are paid and strict control of clinical judgment and practice, the two main business tools of managed care.