It turns out to be surprisingly common. According to the October Harper’s index bq. Percentage of U.S. doctors who say they have not told patients about a treatment because their insurance didn’t cover it : 31 In major public hospitals, the provision of expensive medical treatment to public patients drains fixed budgets. In some cases, the hospital must restrict access to these treatments. The resource allocation problem presents many ethical challenges. But should public patients be informed of treatment options that are not available on the public charge and that, in the view of the doctor, they cannot afford? Many people are inclined to say that there are circumstances where it is a kindness to protect ignorance: to ‘protect’ a patient from a decision whether, for example, to mortgage their house or sell their car in order to pay for an expensive treatment. They argue that withholding information is a part of the duty of a doctor acting ‘in the role of a parent’ at a time when the patient is under stress due to illness or hospitalization and may have reduced capacity for decision-making due to stress, anxiety or drugs. But is it ever ethical to deny a conscious, basically competent adult—whatever their state of mind—full autonomy of choice? When we say a person ‘cannot afford’ a treatment, we might mean that they do not have the resoures in any case to pay for the treatment: the funds are simply not available. But sometimes we mean that they value other things more and choose, for example, to keep the car rather than the more expensive prosthesis. This is a choice about preferences. When, if ever, is a medical practitioner justified in making a preference decision for a competent adult?