This book investigates the fundamental tension between the financial viability of health care organizations and their commitment to providing ethical, high-quality patient care. The authors, all prominent figures in medical ethics and health policy, argue that financial sustainability—the 'margin'—is not merely a corporate goal but a prerequisite for fulfilling the 'mission' of patient welfare. They propose a framework for integrating ethical decision-making into the operational and fiscal structures of health care institutions, moving beyond simple compliance to proactive ethical excellence.

Experts in health administration and bioethics frequently cite this work as a foundational text for understanding the intersection of business management and clinical ethics. Readers often note the pragmatic approach the authors take, which avoids abstract theory in favor of actionable institutional policy recommendations.