A woman presents to her physician with a newly diagnosed condition that in her considered and informed judgment requires an elective surgical procedure. The physician, after speaking with her, agrees that this is an acceptable option. The procedure in question is in fact one of the commonest surgeries performed on American women. The physician is also aware that although the procedure is deemed elective in this and in most cases, research has shown that the consequences of not providing the procedure when it is requested can be severe in terms of both physical and emotional sequelae—in fact, the woman's death can be a worst-case result when the procedure is denied. However, this senior physician is also aware that the procedure is controversial, and that ever fewer of his (now mostly younger) colleagues perform it, either because they are not appropriately trained, not so inclined, or fearful of becoming the target of vocal and even violent opponents of the procedure. In fact, he knew of seven American physician colleagues who had been slain in the past five years for providing this procedure, and of 16 more attempted slayings. Seeking an appropriate referral for this patient, the physician learns that she will have to travel hundreds of miles, involving considerable additional expense and delay—which itself can add to the complexity and risk of the procedure. Presented with this option, the patient expresses dismay but also her resigned commitment to follow through with this referral, and leaves the office in tears.