Introduction by the column editor Any health care system that provides care to individuals in the context of a budget for a population must establish priorities for allocating resources. Establishing priorities is ultimately a process of questioning our values; it is, in other words, a process of ethics. A severe weakness of the U.S. market-based system is that to date it lacks any guiding ethical vision (1). In this column, Robert Rosenheck, M.D., and his colleagues report on an important effort by the Department of Veterans Affairs to articulate an ethical vision for a VA resource allocation policy. Future columns will present other efforts in the managed care arena to make ethical considerations an active force in shaping policy and practice.