Ethical dilemmas arise with regularity, indeed daily, in the practice of rheumatology. As such, the practitioner must have the sensitivity and capacity to recognize them, reflect on their implications, and formulate responses directed at their mitigation. This article presents relevant ethical considerations (old and new) arising in the contemporary practice of rheumatology. A number of considerations stand out for their relevance to the rheumatic diseases. Conspicuous among these are the high costs associated with modern antirheumatic therapy, the complex relationship between physicians and the pharmaceutical industry, as well as challenges to the provision of care to patients suffering from complex chronic diseases. In this regard, patient autonomy is discussed, as is the need to insure for the provision of the time and resources for adequate patient education. The importance of such concerns goes beyond the patients' themselves extending to the future generation of physicians who we will educate.