The decision-making process is at the core of ethics and medicine. Family physicians in residency training spend three years learning to make decisions with, for and about patients and their health care. Most of these daily decisions have potential ethical implications. Competent family physicians must be able to recognize the ethical considerations in the care of patients in both in- and out-patient settings. Family physicians should understand that there are multiple influences on both patients and health care providers, such as culture, education, religion, personal and family values and social and individual experience. The ultimate concern of the family physician.