We explore whether we can reduce paternalism by increasing patient autonomy. We argue that paternalism is about the doctor-patient relationship whilst autonomy is an ethical value. This makes it unlikely that one can be diminished by prioritising the other without significant ethical consequences. We argue that autonomy should not have any automatic priority over other ethical values. Thus, balancing autonomy versus other ethical pillars and finding the optimal balance between the patient’s wishes and those of other relevant stakeholders such as the patient’s family has to be dynamic over time. Different countries, different socio-economic contexts and different cultures need to develop ways to optimise this re-balancing process so that any limitations to patient autonomy are for the shortest possible time and in the least restrictive way.