"The fixed person for fixed duties, who in older societies was such a
godsend, in the future ill be a public danger." Twenty years ago, a
single legal metaphor accurately captured the role that American society
accorded to physicians. The physician was "c- tain of the ship."
Physicians were in charge of the clinic, the Operating room, and the
health care team, responsible - and held accountabl- for all that
happened within the scope of their supervision. This grant of
responsibility carried with it a corresponding grant of authority; like
the ship's captain, the physician was answerable to no one regarding the
practice of his art. However compelling the metaphor, few would disagree
that the mandate accorded to the medical profession by society is
changing. As a result of pressures from a number of diverse directions -
including technological advances, the development of new health
professionals, changes in health care financing and delivery, the recent
emphasis on consumer choice and patients' rights - what our society
expects phy- cians to do and to be is different now. The purpose of this
volume is to examine and evaluate the conceptual foundations and the
moral imp- cations of that difference. Each of the twelve essays of this
volume assesses the current and future validity of the "captain of the
ship" metaphor from a different perspective. The essays are grouped into
four sections. In Section I, Russell Maulitz explores the physician's
role historically.