A recently hired U.S.-trained sales account manager at Medical Equipment Inc. (Medical Equipment) returned to his office after meeting with the head of the cardiology department at a specialist hospital and research center in Jeddah, Saudi Arabia. He had worked very hard to secure his first sale of US$725,000 for healthcare equipment, but was disheartened when the head of cardiology told him that the hospital's purchasing director intended to give the order to Medical Equipment's main competitor. The competition's sales representative and the purchasing director had known each other for 10 years and the head cardiologist implied that there might be side payments involved. The sales account manager knew Medical Equipment's product was superior and wondered how he could secure the order without having a history with the purchasing director or without engaging in practices he found ethically questionable.