In planning for and throughout a pandemic influenza crisis, difficult decisions will be made that are fraught with ethical challenges. Our framework around ethical proc-esses is based upon the "accountability for reasonableness" model developed by Daniels & Sabin [26] and adapted by Gibson, Martin & Singer [27] . This model provides a useful means of identifying the key elements of ethical decision-making processes. An extensive literature has developed around Daniels' and Sabin's accountability for reasonableness framework. The Daniels and Sabin framework has broad applicability across institutional settings and priority setting situations [28] [29] [30] [31] [32] [33] [34] [35] . Because the Daniels and Sabin framework applies deliberative theories of democratic justice to the specific problem of health care priority setting, and because it is unique in this regard, we felt it promoted the kind of deliberative approach to pandemic planning that this ethical framework is intended to support. Table 1 outlines the characteristics of an ethical decision-making process. Stakeholders will be more able to accept difficult decisions during a pandemic influenza crisis if the decisionmaking process has, and is perceived to have, ethical legitimacy.