The ethical underpinnings of writing about patients are explored, the question of how best to undertake the writing of case reports being subordinated to a more general question about the ethics of choosing how or whether to write. An unsolvable paradox is encountered here: that we need to write or speak about our clinical work in order to conceptualize and understand the work we are doing, but that in the very gesture of doing so, we are breaking a fundamental bond with the patient. This conundrum is viewed from a number of vantage points. The controversy about how best to go about writing clinical accounts is first addressed, after which the literature is reviewed to draw out the ethical conflicts that writing about patients engenders in the patient. Next attention is given to undercurrents in the analyst's motivation to write, again drawing on current literature. Finally, a consideration is provided of how, based on what we might learn from this review, these problems can be addressed.