Five years ago, the provocative title of Victor Fuchs' book Who Shall Live?1 alerted the public to the serious consequences of the developing struggle between unfulfilled demands for funds to preserve health, and finite resources. The subject was not unique; for example, Hiatt2 in his description of the "medical commons" in 1975 and Dunlop3 in his presidential address before the American College of Surgeons in 1976, listed some of the reasons why economies were necessary. More recently, the Committee on Issues of the American Surgical Association, under the chairmanship of J. D. Hardy,4 after a year of study published a succinct report that summarized the actions surgeons can take to aid in the resolution of this enormous problem.
For several decades, political measures have been instituted for the same purpose in many countries. Regardless of what is done or who does it, clearly there can be