Introduction

Debates about twentieth-century medicine have been characterized above all by an increased preoccupation with the delivery of health-care services. Underlying this preoccupation has been the fundamental assumption that personal health care delivered by a doctor to a patient, whether in the home or in a hospital, is a worthy endeavour that should be widely available. The belief in the progressive power of scientific medicine to cure has been largely shared by policy makers and consumers, as well as by the medical profession itself. In turn, this belief has sustained the view first, that doctors are the best people to determine the content of medical services and second, that developments in medical care should be made available to as many people as possible. The latter view has necessarily involved greater collective effort and a larger role for the state. It is only very recently that faith in the capacity of the medical profession and state medical services has begun to falter. During the 1980s, support for the medical profession in its task of making us healthier and for an increasing role for the state in making medical services more widely available has been questioned.

While the twentieth century has thus been marked by an overarching consensus as to the value of scientific medicine, below this there has nevertheless been considerable room for conflict. The interests of the three major groups of protagonists – the medical profession, ‘ consumers ’ and the state – have often differed, and these conflicts have become of paramount importance when faith in the medical profession and in the role of the state in providing medical care are called into question.