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.”

I turn now to a document I received from the General Medical Council recently through the post. Gross would surely have anthologised it if he had lived, because it certainly shows one of the resources of English prose. Here is what the UK Revalidation Programme Board will do: “(a) Clarify the assumptions and context for delivery; (b) Confirm the scope of the programme and its major interdependencies, including managing performance concerns in relation to doctors; (c) Define the workstreams needed to deliver all aspects of the model and identify who is responsible for delivery; (d) Provide a clear timetable and key milestones for starting revalidation and incremental implementation; (e) Ensure that all key interests are confident that readiness is being assessed on a robust and consistent basis against UK wide criteria; (f) Outline an end state picture across the UK as a part of the planning process for roll out and implementation.”

Social historians of the future will marvel that eminent, educated people should have consented to put their names to such a document, which in Newspeak would be esteemed as “doubleplusgood duckspeak.”

Recently, I happened on a slim volume in a charity thrift shop (in England, even the organisation of these shops is morally and intellectually corrupt, but that is another story) titled How Shall I Word It? – a Letter Writer for Men and Women on Domestic and Business Subjects. This edition was published in August, 1943, at the height of the war, when extermination was under full swing. It is curious to think that, while people were being gassed at one end of Europe, other people were fretting about how to address a letter correctly to a Dowager Duchess. Since then, of course (and not unconnectedly), vulgarity, being democratically achievable by all, has become a virtue, and daintiness a kind of treason to the self.