Abstract
The proliferation of managed care has introduced conflicts of interest in health care that can create tension in the traditional care provider-patient relationship. In order to address the emerging trends and potential ethical dilemmas presented by managed care, health systems must develop a framework for intentional ethical reflection. The article outlines the essential elements of a caring ethical framework and describes how one integrated health system created a framework of ethical guiding principles and an ethical organizational structure to facilitate integration of those principles throughout the organization.