Addresses the doctor–patient relationship in the context of historical and current considerations of psychiatric authority as well as patient self-determination and loss of mental capacity. Develops a model of the doctor–patient relationship in terms of mental capacity and identifies associated negative and positive psychological processes. Views change and adaptability as both realities and sources of hope. Suggests that the pre-modern Hippocratic relationship is now unworkable and that the doctor–patient relationship in the modern state is out of equilibrium whilst still at the heart of care. Recommends that better understanding the doctor–patient relationship within the modern state is a priority for psychiatric ethics.