Accountability for reasonableness (A4R), widely popularized by Daniels and Sabin (2008), has become a widely used ethical framework to work through the challenging issues of resource allocation with fairness and deliberation. There are certainly significant issues with the framework, but it has helped many delivery organizations open up the discussion of the allocation process in a principled and responsible fashion within an institutional framework (Daniels and Sabin 2008). What this framework has brought us for ethics, we are lacking for quality. We need clearer accountability for quality (A4Q).