The purpose of this paper is to examine the issue of "incontinence" as discussed by Mitcham (1983) — that is, whether it is possible to know the good and not to do the good — by considering the responsible and irresponsible applications of Western biomedical technology among the Puyallup Indians of Washington State since the time of their recorded direct contact with Western culture in 1798 (Morgan, 1979). In order to accomplish this goal, an expanded model of continence-incontinence will be presented which can be applied to a multicultural, multiracial culture-contact situation. The ethnographic information upon which this paper is based is derived from an ongoing ethnohistorical study of the impact of Western medicine on Puyallup Indian culture (Guilmet and Whited, 1985).