In the field of healthcare, ethical considerations are omnipresent. The problem is that it is not clear how to introduce professional ethics within the frontiers demarcated by economic rationality. In mainstream economics, medical altruism is defined as the inclusion of the patient’s welfare in the doctor’s utility function. This definition presents two serious problems that we develop in this paper. The first problem is that mainstream theory does not propose a model of authentic altruism because it reduces otherness to a source of utility like any other. The second problemis that ethical and altruistic (instrumental or otherwise) behaviour should not be conflated. By reducing ethics to altruism, mainstream theory prevents any genuine discussion of medical ethics. Then, the thesis of the paper is that the attempt tointroduce altruism into the standard framework creates theoretical paradoxes that create policy dilemmas