PIP: Health care professionals are expected to base their practice on a set of ethical principles, including truthfulness, beneficence, nonmaleficence, justice, and confidentiality. Dilemmas can arise, however, when a medical professional is called upon to act in opposition to personal values or in cases where the values of patient, health care worker, and sponsoring institution conflict. The author outlines several of the ethical dilemmas that have arisen in community medicine in Sri Lanka. Since preventive medicine is based on the assumption that protection of public health is primary, individual rights and freedom of choice may be overruled, as, for example, in the case of mandatory testing and isolation for communicable diseases. Numerous ethical dilemmas arise in family planning, including whether physicians are mandated to refuse women a permanent method of fertility control when the required spousal consent has not been obtained. In these cases, the physician must weigh the administrative requirement for spousal consent against the principle of physician-patient confidentiality. Physicians are also placed in a difficult situation when patients request Depo-Provera--a contraceptive method that has been banned in the US due to its side effects but remains available in Sri Lanka--or postcoital contraception given the illegality of abortion in the country. Throughout the Third World, physicians constantly encounter challenges to the ethical principle of just, equitable distribution of health care resources.