The paper analyses the factors involved in a series of decisions by the Newcastle Area Health Authority concerning the future of one of its hospitals, as an illustration of the way in which choices about priorities in the health service are actually made. There is no easy way to resolve the various conflicts of interest, notably in this case the competing demands of acute and chronic medicine. Difficult decisions are made more difficult, however, by the over-rigid division of medicine into compartments, by mistrust between the medical profession and administrators, and by the inordinately long time-scale of the decision-making process. It is suggested that there might be value in acknowledging explicitly that occasional examples of 'heroic medicine' must not be allowed too much influence in shaping public expectations. The paper results from the deliberations of a working group on current medical-ethical problems, set up under the auspices of the Northern Regional Health Authority (I).