Try the following nightmare. You are a policeman on the Titanic whose job is to decide who gets a place on the lifeboats—there is only room for one in three. “First come, first served” won’t work as the crowd is swirling around you shouting, threatening, disorderly. How do you choose? Youth before age?—the young have many more years to gain. The fittest first?—better equipped to survive. Those who have been in a shipwreck before?—you know they can handle it. The rich and famous? Your own family and friends? The people with the loudest voice? The crowd is becoming menacing. Coolly you reach into your pocket and pull out a slim volume “Lifeboats—an evidenced based approach”. You start to read “do more good than harm . . ., fairness and equity . . ., the greatest good for the greatest number . . .”. You turn the page—the rest of the book is blank. You wake to find you are a simple chest physician with a patient who needs a lung transplant. Not enough donor organs, not enough evidence, not enough consensus. Should decisions be made by individual doctors on behalf of individual patients or is there now enough experience and agreement for …