This month's issue provides a forum for exploring ethical challenges in emergency medicine. Often individuals treated in the emergency room do not have established histories with the physician. This lack of familiarity makes already difficult encounters—dealing with patients who want to leave AMA (against medical advice) or communicating with families about their deceased loved ones' desires to be organ donors—that much more challenging. At the same time, there are other patients who are all too familiar to emergency room physicians. Many of these patients use the ER as their source of primary care because they lack health insurance. These uncompensated ER "office visits" place significant cost burdens on hospitals. But ability or inability to pay cannot determine whether a person receives care in a potentially life-threatening situation; it is not consistent with medicine's tradition to provide charity care—and it is against the law.