KIE: This Hastings Center Report supplement is derived from the Center's three-year "Ethics and Chronic Illness" project. The project was premised on the idea that chronic illness is a distinctive experience, and that chronic care is different in nature from the acute care that is the current focus of American medicine. In our aging society, the prospect of widespread disability and chronic illness is "a spectre haunting the American health care system." The reality of chronic illness could transform many pervasive assumptions about medical goals and ethics. With this report, the authors intend to stimulate a broader discussion of the ethical issues distinctive to chronic illness, and to outline an agenda for future bioethical investigation. They also hope to articulate the rudiments of a moral vision to guide the health care system, welfare services, families, and communities as they face the challenges of providing chronic care.