Assessment and intervention in public health nursing are intricately linked to health promotion. Health promotional strategies in turn focus attention on life-style modifications. A broad base of research warns of the dangers of the "ideology of choice" that currently accompany such lifestyle-change attempts. The "ideology of choice" is inherent in pervasive views that individuals are "responsible for" and "choose" their disease. The rhetoric of individual responsibility pervades the discourse around both health promotion and health care reform. Without continual awareness of both the complex and multifaceted nature of such life-style "choices," and the balancing of a compassionate stance toward human frailty, health promotion attempts easily degenerate into a victim-blaming stance. Public health nurses need to be particularly aware of these dangers during this period when cost constraints are generating more pervasive "ideology of choice" rhetoric, targeting those with the scarcest resources and the most profound needs.