This article addresses several ethical, regulatory, and legal issues i
n managed care with attention to recent court cases that focus on phys
icians' responsibility, fiduciary duty, and the impact that these lega
l decisions have on physicians practicing in a managed care environmen
t. Discussion of the impact of changes in the control of decision-maki
ng processes for physicians, the use of managed care protocols, restri
ction of resources, and gatekeeping systems are addressed as are the s
pecific duties and obligations of physicians to their patients. (C) 19
97 by Elsevier Science Inc.