Whither utilitarianism?

In an OpEd piece in this morning's Wall Street Journal, Betsy McCaughey attacks Ezekiel Emanuel, an oncologist and medical ethicist at the NIH, for his view that in making medical decisions physicians should not only take into account the needs of the individual patient but those of society as well. She argues that this is a dangerous way to think. But it's ironic coming from a woman who when not attacking health care reform is writing and speaking about the dangers of multidrug resistant organisms. If physicians made decisions purely on the basis of the need of the patient without regard to a greater collective good, then the entire concept of antibiotic stewardship would be abandoned. With that thinking doctors should prescribe the most potent and broad-spectrum antibiotic in every case without concerns for the development of antibiotic resistance that reduces our ability to have effective antibiotics for the future. As I see it, the thoughtful physician often thinks of the impact of decisions beyond his or her patient. And that's really no different from how a thoughtful human should approach life in general. The real argument in the healthcare reform debate, which underlies the tension between the views of McCaughey and Emanuel, is whether health care is a public good or whether it's a commodity. Unfortunately, the United States can't seem to figure that out.