During the same twenty-five-year period in which medical or bioethics established itself as a serious discipline in mainstream philosophy and medical education, an extensive literature on medical institutions and practices, work in the history, sociology, and anthropology of medicine, also appeared. However, philosophical problems have often been posed in ways that have not allowed such social scientific analyses of medicine to contribute much to what have come to be regarded as the major ethical issues in the field. My attempt in the following is to suggest a way of framing the ethical problems in modern medical practice so that consideration of the historical, social, and cultural dimensions of medicine must play an essential, not merely illustrative or incidental role, in what comes to count as an ethical problem and its possible resolution. This will require some (inadequate) attention to quite a comprehensive claim – the dependence in principle of any philosophical assessment of norms on a comprehensive social theory – but for the most part the defining issue in the following is the problem of the social authority of physicians. I attempt to draw out from a consideration of this issue implications that suggest a possible alternative to liberal, voluntarist (or informed-consent) accounts of “legitimate authority” as well as to familiar attacks on such liberal notions of authority, attacks that might all be loosely labeled “ideology critique.”