Of the many ways to conceptualize the relationship between modern medicine and moral principles, by far the most reassuring is the idea that technically good and morally good medical care are one and the same. There are no contradictions, in other words, between the claims of moral obligation and the canons of scientific medical practice. In a trivial sense, this is undoubtedly correct. It is immoral to profess medical competence that one does not have. Ethical medicine presupposes technical knowledge and skill. But what of the far stronger proposition that authentic technical competence inevitably generates ethical practice? As might be expected in complicated human affairs, this statement is only partially true.