I responded to the invitation to comment on this article with some diffidence. Firstly, the authors are to be congratulated for encouraging debate on an issue central to public health; namely the inherent conflict between the responsibilities of the individual and those of society.1 Secondly, I fully agree with the main thrust of the paper. Doctors must always be very vigilant about the roles that society tries to force upon them. In the century now closing there are plenty of historical warnings of where medical subservience to the demands of particular societies ultimately leads.2-5 Thirdly, as one who speaks no other language than his own, I am full of admiration for those who can argue difficult concepts in a second language. Some of the terminology that I would otherwise criticise may be no more than translation errors or linguistic misinterpretations.

Nevertheless, as the authors themselves agree, we are all ultimately responsible for our actions. In ordinary social intercourse we make judgements on the actions of others and attribute responsibility. We can no more “blame” illness on social or genetic determinants than upon an “act of God”. Ultimately we hold people accountable for their actions and there is no obvious reason …