The debate about justice and health care has occurred largely at a remove from the institutions it concerns; it has been about our most general moral principles, and about what things we value. This debate has foundered. But if the debate is turned in another direction, toward some moral principles that are widely accepted within those institutions, and toward principles that have to do with control over allocation decisions rather than with actually how to make those decisions, agreement may be (...) nearer at hand. (shrink)

Modern American medicine has wedded scientific advance to a small business model of the individual practitioner, defining professionalism as technical understanding. If the profession is to survive, it must draw on older ideals of the learned professions as acting on behalf of the community, and reinvigorate a civic understanding of professional life.

Medical ethics is a footnote to the larger problem of directing our technology to good human ends. Written large, then, medical ethics must ask five basic questions.