We wish to clarify two points raised by Eric Topol in his review of our book Everybody Wants to Go to Heaven but Nobody Wants to Die (Nature 572, 308–309; 2019).

First, mitochondrial-replacement therapy is still banned by the US Food and Drug Administration, and we say nothing to the contrary. In the book, we note that “in 2016, committees in both the United States and the United Kingdom gave cautious green lights for mitochondrial replacement therapy” — not that any US regulatory agency had done so. The reports we cite were produced by the US National Academies and the Nuffield Council on Bioethics in the United Kingdom, where the Human Fertilisation and Embryology Authority regulates applications of the therapy.

Second, we do not argue that we have witnessed a complete collapse in the practice of medical paternalism. Rather, we document the many ways in which bioethics and popular American culture have challenged the prevalent view of half a century ago that ‘doctor knows best’. The national conversation on bioethics can help to ensure that the voices of patients are increasingly heard.