Diagnosing for administrative purposes: some ethical problems.

The performing of medical evaluations which result in the awarding or denial of substantial material benefits to claimants in the absence of therapeutic intent creates a situation in which traditional values of medicine cannot operate and raises many difficult ethical questions. The certifying physician is not accountable for the psychosocial consequences to the claimant of denial or direct gratification of basic needs even if these consequences can be determined. With the loss of therapeutic intent, the physician is more likely to be influenced by personal rather than professional values. Because of the adversary nature of these proceedings, the physician is placed in a classic 'double agent' dilemma which may reverberate his own internal conflicts. Since certification determinations often have 'life-and-death' economic consequences for disadvantaged claimants, the 'ethics of reality' may ultimately transcend all other ethical concerns. Perhaps a first step in clarifying these ethical issues would be to make a clear-cut distinction between diagnosing for administrative purposes and diagnosing for therapeutic purposes.