Professionalism and Medicine's Social Contract with Society

The social contract, an idea derived from political science, has recently come to be used to describe the relationship between the medical profession and the society which it serves [1-5]. Medicine's contract with society has always been more implicit than explicit. It functioned reasonably well when both medicine and society were relatively homogeneous, sharing many values. Medicine knew what society expected of both individual physicians and of the profession as a whole. The obligations of physicians necessary to sustain the contract were understood and passed on by respected role models. For its part, society understood what it wanted from those responsible for the care of the sick. Societal obligations were present, but less clear. Society granted physicians status, respect, autonomy in practice, the privilege of self-regulation, and financial rewards on the expectation that physicians would be competent, altruistic, moral, and would address the health care needs of individual patients and society This "arrangement" remains the essence of the social contract.