The intersection of financial considerations and patient care is fraught with conflicts of interest and, frequently, with accompanying ethical dilemmas. Inpatient rehabilitation is a unique component of the health care delivery system and presents a distinctive set of ethical dilemmas, including issues of patient autonomy and decision making. This article focuses on the particular issue of resource allocation and the determination of inpatient rehabilitation hospital length of stay. The challenges posed by uncertain endpoints as goals of rehabilitative care and the psychological aspects of recovery from major disabling illness are among the issues confronted by health care providers in the rehabilitation setting when they try to balance patient and institutional goals.