Bok concedes that paternalism is not always and in every case wrong. But if paternalism is not always wrong, then there must be an ethical principle morally anterior to, or higher than, the right to patient autonomy: for first must come the doctor’s decision whether the case before him is one in which his duty to be paternalistic over-rides the patient’s right to autonomy.

These are difficult questions over which philosophers have wrestled, without coming to any indisputable conclusion, for millennia. I remember how, once, all fired up by the relatively new first principle of patient autonomy, I explained to a patient the statistical logic of antihypertensives: how the chances were that they would do him no good, but how, if they did do him good, it would be a very great good. Then, at the end of my little disquisition, I asked him whether he wanted to take the pills or not.

“I don’t know,” he said. “You’re the doctor.”