This is a case that speaks directly to the issue of an organization's mission. As private insurance and government reimbursement decline, the economic pressures facing healthcare systems both public and private continue to increase. For many institutions it is no longer a question of prospering but surviving. As this case accurately describes, survival is dependent on continually reducing costs and maximizing reimbursement. These strategies often include reducing the number of nonpaying or charity cases while attempting to remain faithful to the mission of the organization, whether this be a religious or civic mission. The ethics committee, although it may be an appropriate forum for discussions to begin concerning this patient, is not the appropriate decisionmaking body regarding whether this gentleman receives the treatment he needs. That task should fall to whichever group defines or articulates the mission and values for the organization, normally the hospital's administration in concert with the board of directors or trustees.