[We had an unlimited budget and we have exceeded it...].

The extraordinary costs involved in medical innovation leads, inevitably, to financial restrictions. Doctors need to involve themselves in the decision making process, difficult as this may be. Otherwise, health administrators will assume the full responsibility for decision making, as has become the case in the United States. Doctors must be particularly wary that financial restrictions impinge on neither medical progress--through subtle cut-backs--nor on the fundamental ethical principals--such as a decision to reduce the intensity of care in patients with complications.