Over twenty years ago my partner, who was a very good physician, would occasionally say somethng that puzzled me. He would say we probably should not do such and so for a given patient because of the cost to the society or the system. Sometimes he used one word sometimes the other. I let it- go we had a great working relationship which I did not want to damage it with philosophical discussion in which we would each probably talk past the other.
He was ahead of curve of the philosophy of population medicine- a philosophy that places importance of the health of a group or a collective as opposed to the individual's health which had been the emphasis and the polar star for the physician in the centuries old physician-patient relationship.
But the health of a group had never been the role of the physician-it was the health or well being of the person acrosss from him in the examining room. The fundamental ethic of the medical profession stood in oppostiton to the notions of population medicine. For the notion of population medicne, which included reference to social justice,and a utilitarian calculus to prevail medical ethics had to be chosen.
Leading the charge for change were a group of leaders of the American College of Physicians and some like thinking European internists.