How does a surgeon balance the usefulness of clinical evidence with the need to improvise according to unpredictable complications? When can surgery, so often associated with saving lives, be useful for care at the end of life? How much risk should research subjects be exposed to in the hopes of confirming (or disconfirming) a clinical hypothesis? What value, if any, would a regulating body like the FDA have for surgery? What should surgeons do when they confront the limits of their own competence? These and other ethical questions are addressed in this month's issue.