PREAMBLE: This article is written by the "Medecin cantonal" (Chief Medical Officer) of the Swiss Canton of Vaud (capital city, Lausanne). Under the Swiss Constitution, responsibility for most health-related issues lies with the Cantons. The "Medecin cantonal" is the medical advisor to the health minister and the cantonal government. His or her traditional role concerned the organisation of health care delivery, such as the distribution of hospitals and licencing of practitioners, as well as health promotion, school health and disaster preparedness. However this has changed considerably in the face of health threats, such as HIV/AIDS and the rise in drug addiction. These bring new and complex challenges, and in particular bioethical concerns. In this personal view the author discusses his experience at this intersection between medicine, health care, the exercise of public authority, politics and civil society. In particular he reflects on how physicians and politicians have different perspectives on the circumstances of collective life.