Background: The German Diagnosis-Related Groups (G-DRG) system has led to a revenue-orientated hospital financing system. This article examines the ethical implications and consequences of this system using the example of reconstructive measures (defect care) in patients with oral cavity carcinoma. At the same time, the interplay between the G‑DRG system and guideline development must also be scrutinized. This is preceded by introductory information on oral cavity carcinoma and the existing treatment options: conventional reconstruction techniques versus cost-intensive high-end surgery. Methods: The case scenario “treatment of medium-sized defects after tumor resection” forms the methodological basis and argumentative reference point of the study. Results and discussion: The G‑DRG system and the economic incentives lead to far-reaching ethical implications concerning the demand-orientated treatment of patients and lead to multidimensional interactions. The existing tendency towards high-end surgery harbors the risk of overuse and misuse and, therefore, runs counter to the principles of beneficence and nonmaleficence. The one-sided indication in favor of high-end surgery also suggests that patient information is given in a directive manner (violation of respect for patient autonomy). Moreover, costly high-end procedures counteract the principle of economic efficiency and, thus, touch on issues of distributive justice. Finally, the clinical favoring of high-end procedures also affects logic within medicine, namely the publication landscape (publication bias), the design of the relevant guidelines, and surgical expertise. Conclusions: There is a need to raise the awareness of all those working in the field of surgery (surgeons, guideline experts, reviewers).