Moll also is of opinion that this impartial presentation of the case for and against sexual intercourse corresponds to the physician's duty in the matter. It is, indeed, a duty which can scarcely be escaped by the physician in many cases. Moll points out that it can by no means be assimilated, as some have supposed, with the recommendation of sexual intercourse. It is, on the contrary, he remarks, much more analogous to the physician's duty in reference to operations. He puts before the patient the nature of the operation, its advantages and its risks, but he leaves it to the patient's judgment to accept or reject the operation. Lewitt also (_Geschlechtliche Enthaltsamkeit und Gesundheitsstörungen_, 1905), after discussing the various opinions on this question, comes to the conclusion that the physician, if he thinks that intercourse outside marriage might be beneficial, should explain the difficulties and leave the patient himself to decide. There is another reason why, having regard to the prevailing moral opinions at all events among the middle classes, a physician should refrain from advising extra-conjugal intercourse: he places himself in a false relation to his social environment. He is recommending a remedy the nature of which he could not publicly avow, and so destroying the public confidence in himself. The only physician who is morally entitled to advise his patients to enter into extra-conjugal relationships is one who openly acknowledges that he is prepared to give such advice. The doctor who is openly working for social reform has perhaps won the moral right to give advice in accordance with the tendency of his public activity, but even then his advice may be very dubiously judicious, and he would be better advised to confine his efforts at social reform to his public activities. The voice of the physician, as Professor Max Flesch of Frankfort observes, is more and more heard in the development and new growth of social institutions; he is a natural leaders in such movements, and proposals for reform properly come from him. "But," as Flesch continues, "publicly to accept the excellence of existing institutions and in the privacy of the consulting-room to give advice which assumes the imperfection of those institutions is illogical and confusing. It is the physician's business to give advice which is in accordance with the interests of the community as a whole, and those interests require that sexual relationships should be entered into between healthy men and women who are able and willing to accept the results of their union. That should be the physician's rule of conduct. Only so can he become, what to-day he is often proclaimed to be, the leader of the nation."[98] This view is not, as we see, entirely in accord with that which assumes that the physician's duty is solely and entirely to his patient, without regard to the bearing of his advice on social conduct.