If one asks how the medical profession is made legally accountable in England and Wales, the answer is essentially very simple: accountability is achieved through a professional filter. Medical practice is, in effect although not technically in law a professional monopoly, its ethical standards are set and policed by medics, and malpractice suits are almost exclusively based on negligence which turns out to make liability depend on the expert opinions of doctors. While judges have suggested that they might intervene to establish standards, actual activity of this sort has been conspicuous by its absence. The purpose of this paper is to examine how this situation has come about, to examine the ideological framework which serves to legitimate it, and to appraise its current validity. It suggests that law in England and Wales has been dominated by an acceptance of the claims of medical professionalism.1 Following the work of Terence Johnson, this term is taken to denote a particular type of contfol of occupational activity by which it is the producer who defines not only the needs of the consumer but also the manner in which these needs are to be met.2