By James L. Connor, S.J.

All of a sudden, the managed health care system in the United States finds itself at roughly the same berth of popularity as tobacco companies, gun manufacturers, and asbestos makers. Managed care executives are getting cast as the bad guys in television dramas and movies like "As Good As It Gets," which has become an icon of the near-universal hatred of these Health Maintenance Organizations.

There are certainly some venal people in managed care, as there are in all sectors of society, including organized religion. What the HMO horror shows usually overlook, however, is that these executives are operating in one of the more excruciating moral mazes of contemporary American business.

As a Jesuit priest and ethicist who reaches out to leaders of the business world, I have come to know a fair number of managed care executives. As a whole, they're decent people who want to do the right thing. But they work in a corporate culture that often transcends, and trumps, their deepest values.

The bane of healthcare today is the illusion that it's a business like any other. According to this fallacy, delivering healthcare is like making widgets or Nike sneakers. Most people, of course, don't think so. That's because the encounter between patient and provider is not simply an economic transaction. It's a human interaction, a relationship of care. It strikes at the very essence of human well-being.

My friends in managed care understand this, on some deep level. But they also understand the game they're in, and must play by its rules. In business, that means competition and the drive toward market share and profits or revenue (pressures even applying to nonprofit and religious care systems).

The paradox is that by playing this game so exceedingly well, HMOs are losing it. Congress is wielding a bipartisan hammer of legislation, physicians are unionizing, and the specter of costly malpractice lawsuits is haunting managed care organizations. Not surprisingly, the recent financial woes of some big HMOs have garnered little public sympathy.

What managed care could use is a careful dose of moral perspective, for its own survival as well as for the greater good. My general prescription is a strong institutional sense that the business of healthcare is not business; it's care of health. Decision-makers in the system need to begin cultivating the habit of ethical deliberation; for that, they need a corporate climate that encourages discussion of their dilemmas.

Basically, the professional-ethical task is to probe the legitimate claims -- and values -- of various so-called "stakeholders." These include patients and their families, physicians, employers who sponsor health plans, and, in the case of for-profit systems, shareholders.

It is not an easy process, especially when patients and loved ones are demanding coverage of high-tech medical procedures that are costly, experimental, and quite possibly futile. But it is the most practical way of protecting the dignity of all those involved, not to mention the moral standing of these organizations.

Obviously, HMOs won't foster this habit of ethical deliberation as long as they cling to the illusion that healthcare is just a business, trading in a precious commodity. All healthcare leaders and practitioners must think of themselves as pursuing not just a career but a calling -- a "profession" in the venerable sense of the word.

Institutionally, managed care organizations can drive home the message, and steer the case-by-case deliberations, with functional mission statements. These statements must say plainly that the goal of healthcare is caring for health. Everything else, including shareholder return and executive compensation, should be understood as practical means toward the delivery of quality healthcare rather than as ends unto themselves.

Amid the groundswell of demand for a "Patients' Bill of Rights," we should also remember that patients have responsibilities, too. The y have an obligation to understand that medical resources are finite, and that exotic treatment often has diminishing returns, especially in the final months of life. Ultimately, patients need to factor death into the human equation. Organized religion has a distinct role in preaching this word to cantankerous patients who can't accept death, because they really haven't accepted life. Death does not have the last word in the unbounded book of life.

Father James L. Connor, S.J., is director of the Woodstock Theological Center at Georgetown University. The Center sponsors an ongoing seminar in business ethics, which recently produced the consensus document, "Ethical Issues in Managed Health Care Organizations" (Georgetown University Press). This column is adapted from an article in Commonweal.