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ABSTRACT As health care has become of great importance to both individual citizens and to society, it has become more important to understand medicine's relationship to the society it serves in order to have a basis for meaningful dialogue. During the past decade, individuals in the medical, legal, social sciences, and health policy fields have suggested that professionalism serves as the basis of medicine's relationship with society, and many have termed this relationship a social contract. However, the concept of medicine's social contract remains vague, and the implications of its existence have not been fully explored. This paper endorses the use of the term social contract, examines the origin of the concept and its relationship to professionalism, traces its evolution and application to medicine, describes the expectations of the various parties to the contract, and explores some of the implications of its use.
social contract: A basis for legitimating legal and political power in the idea of a contract. Contracts are things that create obligations, hence if we can view society as organized "as if" a contract has been formed between the citizen and the sovereign power, this will ground the nature of the obligations, each to the other.
-Oxford Dictionary of Philosophy (1996)
THE SUBJECT OF MEDICINE'S PROFESSIONALISM has assumed increasing importance during the past decades because of the widespread belief that medicine's traditional values, which are closely linked to professionalism, are under threat (Cruess and Cruess 1997; Freidson 2001; Hafferty 2006a; Krause 1995; Starr 1984; Stevens 2001; Sullivan 2005;Wynia 1999).There is a rich literature that defines professionalism and outlines medicine's obligations as professionals (ABIM 2002; Cruess, Johnston, and Cruess 2004; General Medical Council 2006; Hafferty 2006b; Royal College of Physicians of London 2005; Swick 2000;Wynia et al. 1999).Virtually all observers contributing to this literature are in agreement that professionalism serves as the basis of medicine's relationship with society, and most believe that the relationship is best described by the term social contract.
Based on the concept's foundation in philosophy and political science,we also believe that social contract is the most appropriate descriptor of the relationship. In this article, we describe how the social contract relates to professionalism, define the concept in contemporary terms, and provide an outline of the nature of the...