The leading ethical problem in medical practice for the coming decade is likely to be how to select patients for priority. Criteria for such decision-making in the case of cancer patients are discussed. Clinicians, ethicists and others need to agree guidelines on giving priority to one patient over another when resources are limited, and such criteria need to be approved by society at large. The public must accept that in a non-explicit rationing system, each individual competes with every other. In (...) the case of even more difficult ethical choices, a multidisciplinary national committee is required to advise on decision-making, and its views need to be debated by the general public. (shrink)