© 2002 Canadian Medical Association or its licensors

In the United States, physicians, ethicists and lawyershave long struggled with the concerns associated withformal cost containment initiatives that actively inter-fere with physicians ’ prescribing practices.1–3 Canadian physicians are beginning to experience similar forms of ex-plicit pressure to contain costs. These external factors have the potential to expose physicians to a variety of liability concerns. For example, the imposition of fiscal restraint policies creates unique dilemmas regarding informed con-sent and the standard of care.4,5 In this article, we use a spe-cific example of a financially driven treatment paradigm de-signed by a third party, other than the physician or the patient, to illustrate the possible legal implications of such cost containment strategies. A number of approaches have been used by drug pro-grams of provincial health plans to limit expenditures, such as basing pricing on the lowest-cost alternative and th