Charter on medical professionalism: putting the charter into practice.

The following letters from the readers of Annals represent just the kind of debate about professional ethics we had hoped the physician charter would engender. Seven members of the Medical Professionalism Project have responded accordingly. Although we could not hope to address every issue raised, one does seem salient throughout: the apparent conflict between a patient-centered ethic of care and the commitment to a just distribution of finite resources. We recognize that compromise is necessary between these two principles, but such compromises are at the center of the liberal state’s equilibrium between equality and civil rights. We believe that physicians can maintain an altruistic commitment to their patients at the bedside and still work in administrative and political contexts to develop just rules for distribution. Indeed, this tension, and our efforts to address it, is likely to define the next several decades of ethical health care practice. In that regard, the charter has been successful as a catalyst to promote an action agenda for the profession that is universal in scope and purpose. And it has furthered the collaboration of the ABIM Foundation, ACP Foundation, and European Federation of Internal Medicine in the next activity phase—to advance the charter within the context of exploring the health rights and responsibilities of patients, physicians, and society.