(Despite my misrepresentation: the emergency code for the UK is 999, not 911. I am surprised the Politically Correct Brigade hasn't thought to push for changing that 9/11 number.)

Being in medical school, any idealism about your role is systematically ameliorated and deconstructed. When we submitted our personal statements outlining precisely why we wished to pursue the arduous path of medicine (an admittedly mad decision), a common piece of advice was not to present a picture of unrealistic idealism: they wanted some evidence of the understanding of precisely what a doctor's role actually is, specifically within the framework of the National Health Service. Still, the primary reason for choosing the doctor's role over other professions for most who do is in finding that is worth doing, worth getting out of bed for, worth the comparative loss of sanity, sleep and income to other fields open to you. A role that is both compatible with your personal ethics and perceived to be of inestimable worth to society.

You are allowed to retain some version of naivety and self-righteousness -- sorry, encouraged to be ethical and good -- insofar as it allows you to justify any action to yourself within the safe knowledge that you are doing it either in the best interests of your patient or out of respecting their autonomy: that is, for them to make their own decisions even if you disagree with them.

You are allowed to do a lot of good as part of the medical profession: vaccination, treatment, easing suffering. This is what happens most of the time.

However, there are grey areas. Or even black areas. A problem with being part of a nationalised service or any organisation is that you are essentially an agent of their interests; you may disagree with them but your enforced job is to remain in line with them. You are a slave to political trends and helpless to powers beyond your realistic control.

What faces the future doctor?
We have the financial consequences of the recession, although finances were a problem already. Latest figures from the office of statistics place the public debt at 7.7 billion, compared to surplus at the same time last year. Contributing to this figure is the cost of bailing out banks; figures for the cost of this ranged from billions to over a trillion.

Cost-cutting measures in the nationalised health service are happening and will happen, leading indirectly to loss of life. This can't be avoided.

Euthanasia is currently illegal in the United Kingdom. A matter darker than this is that there is and will be increasing clamour for legalisation and laxity around anti-euthanasia measures. Not only will this benefit the strained coffers of the NHS but the demand increases: as we lose the soft, warm and comforting blanket of the comforts of deranged consumerism, more of the population will find the idea of living intolerable as well as the idea of being a 'burden'. More people will want to be helped to die and it will be easier to say 'yes'.

This is an issue wherever economies are affected and not just a local one.

I wonder -- as an aside -- what the USA motivations for pushing health care reform measures leading to an increase of control by governmental institutions might be amidst a tenuous economic climate? Will Obama's administration abuse this control? Will the next administration?

Again and again, I question and reflect: will I be able to recognise when I'm doing what a good doctor should be doing or am I rationalising that what the NHS wants is precisely what a good doctor is?

Well, we are far away here from the idealistic pre-medical student state where the role of the doctor is to 'save lives.' It is to ease suffering. Like healers before me, I may include dispensation of death within the purview of my role: even though it offends the very foundation of what I intended to study and fight to preserve.

Easing suffering (where do we draw the limit for suffering?) or not: will I be able to make the decision to kill? That remains to be seen.