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No longer can a patient assume that his physician has his best medical interests at heart.

I've often thought that gynecologists should be required to inform all of their patients whether or not they commit abortion. The reason is that if I have a gynecological problem, I simply cannot trust a murderer to have my best interest in mind. All patients have a right to know up front if their physician engages in practices that hasten or cause death, and be given the opportunity to select another physician.

Now physicians are being urged to consider the cost to society of a patient's care and judge whether a patient is worthy of such expense.

That's the whole problem with government paid health care. When "society" is paying the costs, then "society" has the right to decide that some patients aren't worth the cost. Even in the 1970s, I saw articles in NEJM calling for rationing. There would be no such calls if patients had more responsibility for paying for their own health expenses--if health insurance only covered catastrophic events, like other insurance. When a patient decides that a certain level of care is not worth the expense, it is not rationing, and the patient retains autonomy.