Dutch Health Care Reform and Medical Professional Ethics:A Plural Picture of the Good Doctor

The paper examines the influence of health care reform on medical professional ethics. In order to illustrate this influence two cases are discussed. Bases on these cases, I question whether the government deliberately aimed at changing the medical professional ethics. An analysis of authoritative policy documents shows that the government requires doctors to perform three roles: the statesman, the businessman and the professional. The ethical dilemmas that follow from the combination of these three roles are ignored in the policy documents. In the paper possible causes of this neglect are discussed. In the second part of the paper the reaction of the Dutch Royal Medical Association (KNMG) on the new health care system is assessed. Introduction Individual doctors are expected to act in accordance with ethical principles that are shared by the whole medical profession. National as well as international medical professional organizations publish ethical codes and guidelines to inform doctors and society about the norms and values that should guide the behaviour of a good doctor. The term ‘medical professional ethics’ is used to refer to this set of norms and values. Medical professional ethics is not static, but is changing over time. In several respects the medical ethical guidelines published by the Dutch Royal Medical Association (KNMG) in 1936 and the current document that discusses the rules of behaviour, adjusted in 2002, are different (NMG 1936, KNMG 2002). Several developments can