The American College of Physicians' Ethics Manual is designed to help facilitate the process of making ethical decisions in clinical practice and medical research. The fifth edition of the Ethics Manual examines emerging issues in medical ethics faced by internists and their patients and revisits older issues that are still very pertinent. The distinction and potential conflicts between legal and ethical obligations when making clinical decisions are discussed. New or expanded sections have been added including third party evaluations, confidentiality, complementary and alternative care, boundaries and privacy, gifts from patients, care of patients at the end of life, solid organ transplantation, physician-assisted suicide, the changing practice environment and managed care of ethics, physician-industry issues, selling products out of the office, health and human rights, patient safety, prisoners as patients, strikes and joint actions, consultation and shared care, and research ethics