Some ethicists believe that doctors should be like hairdressers. If you ask a hairdresser to shave your head, he or she will most probably do so. Similarly, such ethicists would argue, if a patient asks to have whiskers surgically implanted or his penis enlarged by injecting fat into the shaft (penoplasty), the surgeon should perform the operation once satisfied that this is what the (competent) patient truly wants. Increasingly, medical professionals are involved in procedures that, to most people, are distinctly odd. The principle of respect for autonomy—still gathering moral weight since its modern birth in the 1960s—seems to be constraining doctors' decision making to such an extent that they are no longer sure if they know what is best for patients. When they do know, they wonder whether communicating this is respecting patients' autonomy or violating it.

What does patient centred care—that current buzz term—require? Are doctors wise gatekeepers of medical …