(The following resolution was  adopted nearly unanimously by the Medical Staff of Lawrence and Memorial Hospital  on March 31, 1995.  Subsequent events nation-wide have confirmed the wisdom of this position, which remains in effect.)

WHEREAS, the relationship between physician and patient has as its foundation the TRUST of the  patient in the physician’s commitment to placing the patient’s welfare above all else; and

WHEREAS, that relationship has long been defined in Ethics and in Law as a FIDUCIARY relationship, and

WHEREAS, current efforts, in the form of mandatory GATEKEEPER AND CAPITATION MECHANISMS, to make the physician an insurer of the patient’s health  place the physician at personal economic risk for the quantity and quality of services he renders to the patient by rewarding the physician for providing less and less specialized care; THEREFORE,

RESOLVED, that the PERVERSE INCENTIVES inherent in mandatory gatekeeper and capitation mechanisms - directly placing the physician’s financial well-being in opposition to his patients’ well-being - are INHERENTLY UNETHICAL, and are incapable of being legitimized through any mechanism of alleged “informed consent”.  Be it further

RESOLVED, that the American Medical Association communicate this position by all appropriate mechanisms to its members, to non-member physicians, to  Federal and State governmental bodies, and especially to the general public.

GS