As we move into health care reform, the issue of health care rationing is coming to the fore. Instituting Futile Care Theory—the putative right of a doctor to refuse wanted life-sustaining treatment based on his or her values as to the quality of the patient’s life—is the opening gambit because it targets those thought to be on their last legs. Now, the Journal of Critical Care Medicine has published an article intended to open the debate as to whether doctors have a social duty to impose medical futility. This is nothing less than the deprofessionalization of medicine by imposing upon (or granting to) doctors a dual and sometimes conflicting mandate—one to provide the patient optimal care and the other to deny optimal care based on social duty. For more details, check out my post over at Secondhand Smoke .