¶ … grey areas associated with medical ethics is that executive personnel in the medical community are not always subject to the same rigorous ethical codes that other workers in the field are. Arthur Lazarus notes, "American Medical Association (AMA) Principles of Medical Ethics provides norms for treating patients, but provides little guidance for physician executives in terms of helping their organizations comply with legal and regulatory requirements, avoiding litigation, improving productivity and quality and building organizational trust and integrity." This is particularly true regarding executive practitioners in nontraditional medical fields and private practice. Fundamentally, the wide variety of organizational settings in modern medicine can generate an atmosphere where the straightforward application of any single code of ethics is simply not possible. Additionally, modern ethical codes need "to reflect the medical technology industry's unique relationships with health care professionals."

So, while the doctrines set forward by the AMA, American Psychiatric Association, American Association of Psychiatric Administrators, American College of Healthcare Executives, and the American Academy of Pharmaceutical Physicians all provide detailed and useful guidelines for ethical conduct in the actual administration of medicine, broader social and moral conflicts can arise in which medical executives are forced to make difficult decisions.

Lazarus, a psychiatrist employed in the pharmaceutical industry, finds that all of these ethical codes could potentially apply to his practice. He writes that "many pharmaceutical physicians adhere to the AAPP code of ethics, which basically guides ethical decision making related to patients (subjects) in clinical trials, but not to patients seen in clinical practice."

However, this code is far from comprehensive with reference for to psychiatrics in managed care positions. Overall, the conflicts that exist between existing codes of ethics when it is unclear as to whether one or another should be applied undermines the validity of all the major ethical standards in medicine.

One problem has arisen...

The problem was that the APA standards were set before the era of managed care; accordingly, the application of the APA code of ethics to these particular psychiatrists was utterly ambiguous. Psychiatrists in managed care essentially need to conduct insurance reviews for their practices to function properly, but from the perspective of the APA this was a grievous breech of medical ethics. Eventually, "The psychiatrists were exonerated, and later an addendum to the APA's code of ethics was incorporated to clarify existing standards for psychiatrists practicing in 'organized settings.'"
The APA's central goal is to set forward a code of ethics that is capable of providing the best possible care for the patient. Consequently, the addendum that addressed this specific issue fell in line with this approach:

A psychiatrist shall not conduct reviews or participate in reviews in a manner likely to demean the dignity of the patient by asking for highly personal material not necessary for the conduct of the review. A reviewing psychiatrist shall strive as hard for a patient he or she reviews as for one he or she treats to prevent the disclosure of sensitive patient material to anyone other than for clear, clinical necessity.

Although this statement is relatively linear in its reasoning, it is also exceedingly vague; it leaves the ethical choices purely in the hands of each individual practitioner's judgment. In other words, it is not altogether obvious just what manner of reviews is likely to demean the dignity of any given patient. Certainly, it must be associated with the intimate nature of the information that is required and balancing this against information which might not be as pertinent. However, exactly where the line is drawn is wholly up to the one conducting the review, and again, rests within the bounds of their own judgment.

So, the intended ethical principle that the American Psychiatric Association adheres to is fairly plain: the best possible care for the…