The fundamental questions are not new but their current incarnations are. The old approach to medical ethics assumed everyone was primarily concerned for their patients and shared common ideas of good and evil, and that, therefore, it was not necessary to discuss ethics. With the explosion of technical skills and the growth of cultural diversity this no longer suffices. We are now being told how to behave by an elite secular group of bio-ethicists whose beliefs are not shared by most of our patients. Despite this, we continue to talk about patient centred ethics!