Imagine you are a CEO of a health services organization (e.g., regional health authority, hospital, community care access centre, disease management organization). As CEO, you aspire to meet the health needs of your communities, within available resources, to advance your organization's strategic directions, including its mission, vision and values and (possibly) to fulfil an academic mandate. Your organization is experiencing significant strategic and budgetary pressures. Perhaps your organization has been asked to reduce waiting times for specific health services without reducing other service volumes or compromising quality. Perhaps demographic change in your local catchment area means existing health services capacity is no longer sufficient or appropriate. Or perhaps external factors (e.g., government directives, new technologies, regional health services restructuring, SARS) have placed constraints on your organization's ability to maintain existing health services and volumes. The Ministry of Health has informed you that no additional funds will flow to your organization in the near future, and your CFO tells you that she has exhausted fiscal strategies to release additional resources. You recognize the need to set health services priorities to facilitate resource allocation, but you are worried about how this will affect patients, staff and community partners. Also, your organization is up for re-accreditation this year, and ethics in resource allocation is among the Canadian Council of Health Services Accreditation (CCHSA) standards. How will you decide what your health services priorities will be? How will you know that they have been set ethically?