I must have my head screwed on sideways then. First, in your example, I don't see that "Joe" has a preference for you to die. You are motivated to live, which

I must have my head screwed on sideways then. First, in your example, I don't see that "Joe" has a preference for you to die. You are motivated to live, which boils down to either acquiring medication, or not. Acme pharmaceuticals, however, is not in the business of saving lives -- that's not their motivation. They are in business to make money through pharmaceutical development. They produce a product, and people either choose to use it, or not. All moral judgements aside, they are under absolutely no obligation to provide the drug to anyone. A report by the Tufts Center for the Study of Drug Development in 2003 found that the mean cost of bringing a new pharmaceutical to market was almost $900 million [1]. Let's hedge a little and guess that the cost of developing and releasing a new AIDS treatment comes in at $1 billion -- they're going to need around a million patients at $800/year just to recover their costs and break even in a reasonable period of time, and that's not counting continued costs of manufacturing, shipping, lawsuits, or further research and development. I think it's rather likely that Gilead totaled up their development and recurring costs, factored in a standard profit margin, guessed at their annual sales and did a bit of market analysis, and arrived at a price that kept them in business. Regardless of whether it's morally right or wrong, producing cheap knockoffs of expensive pharmaceuticals is not a sustainable business practice -- even if those cheap knockoffs are equally effective and have the same quality controls in place. The situation only becomes a moral issue if we find that a particular company has developed, and patented, an effective treatment or cure for a particularly nasty disease, and then they have opted to artificially inflate their price. If that's the case, then yes, there is moral justification for producing a black-market version. In all other cases, if you think -- as I do -- that effective treatments and cures for diseases should be available to people regardless of their economic means, then I would suggest that the various countries involved resolve the situation by simply purchasing (or promising to purchase) large quantities of the drug for their citizens. The pharmaceutical company can stay in business and continue its research on the next medication, people get treated, everybody's happy. A nation like India could afford such a deal. Poorer nations could have assistance from the U.N. or humanitarian organizations ... if enough people really believed in making treatment available to everyone. Regardless, I don't think the situation boils down as simply as you make it sound. To paraphrase your last line, it's not your place to decide that nobody ought to suffer at the expense of companies capable of treating them. [1]: http://pn.psychiatryonline.org/cgi/content/full/38/15/25 http://pn.psychiatryonline.org/cgi/content/full/38/15/25