The Declaration of Geneva was recently revised to emphasize patient autonomy and the importance of clinicians sharing medical knowledge.

This reflects the welcome evolution of the doctor-patient relationship from one of paternalism to more informed, shared decision-making.

Unfortunately, there is an increasing trend for clinicians to avoid making recommendations, instead providing a “menu” of care options from which patients and families must choose.

This seems to be underpinned by the belief that it is unacceptably paternalistic to give guidance as to which course of action may be best to take.

In this article, we argue that there is an ethical imperative for doctors to provide medical recommendations.

This is discussed with particular emphasis on the pediatric critical care setting, where autonomy and shared decision-making are especially complex.

We outline how a failure to provide clinical recommendations represents inadequate shared decision-making and erodes the doctor-patient relationship, leading to suboptimal care, paradoxically decreasing respect for autonomy.

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