Resolving competing claims in bioethics dilemmas is never easy. On the assumption that vigorous debate is the most effective ground for reaching reasonable decisions, this annual Open Forum issue is devoted to timely controversies in a number of areas: governmental regulations and reproductive rights, determining fair compensation for gamete donation, balancing responsibilities in the doctor–patient relationship, violating rules to benefit patients, persistent problems in end-of-life care, and professional standards of conduct and bioethics consultation, as well as insights into the shifting landscape of oversight in clinical research and directions for the future.