The Physician’s Role: Patient v. Population

Abstract

AbstractThere is always a tension between Public health and individual medical care. The former seeks, by one ethical optic, a fundamentally consequentialist goal: the greatest good for the greatest number of individuals. The latter has, at its moral base, an encounter between a medical provider and a patient, and its ethical goal is to optimize the outcome that the patient desires. While this dichotomy of intent and effort must be nuanced, setting it out in these terms helps us understand the tensions that we see between Public health initiatives and individual medical care. This chapter will suggest that by examining two movements that attempted to insert larger community concerns into the individual patient encounter, we might gain insight into what happens in the moral space of the patient encounter when the provider is compelled to consider these larger concerns. The Eugenics movement of the late nineteenth and early twentieth centuries, and the population health movement of the late twentieth and early twenty-first centuries will be considered as two examples of attempts to alter the individual patient encounter through the lens of larger societal concerns.