In my feature article in this issue, ‘Doctors, patients and risk attitudes’, I argue that considerations of both autonomy and beneficence support the practice of healthcare professionals deferring to their patients’ reflectively endorsed risk attitudes when making decisions under uncertainty.1 The commentaries written in response to this article present many interesting criticisms, limitations and applications of the view, and I am grateful to all of the commentators for their engagement with this topic. I cannot possibly do justice to all of (...) the points they have raised in this brief response, so I will address two common themes that appear in a number of the commentaries: first, whether the view I have proposed goes too far or not far enough in deferring to individual patients; and second, the epistemic challenge that would be faced when trying to put this approach into practice. Theoretical accounts of the link between preferences and either well-being or autonomy face a familiar tension: if well-being or autonomy are tied too closely to individuals’ actual preferences, one must contend with examples of preferences that seem obviously bad for a person or disconnected from their status as …. (shrink)