The past few years have produced monumental changes in the American health care system. With those changes, questions of ethical conduct now challenge every physician practicing in the United States. Basically, many are asking if it is possible to uphold the precepts of the Hippocratic oath in the world of managed care. In using the term managed care, I am already breaking a promise I made to myself some time ago that I would never use the term managed in conjunction with the term care. We should call it what it really is, managed cost. In any event, let us examine that solemn oath that many physicians took on graduating from medical school and challenge each other to remain true to its fundamental principles.