In the patientphysician interaction, the physician applieshis or her skills and then makes recommendations that he orshe believes are in the patient's best interest. Sometimes thepicture is crystal clear, and the medical pathway largely unambiguous.Often, however, the path to be followed depends largely on thepatient's choice among reasonable medical options; at times,none of the choices are easy or pleasant ones. Today, the federalgovernment is inserting itself into this highly personal setting,where outcomes are often filled with heartbreak no matter whatcourse is chosen.