In many countries milk production per cow has more than doubled in the last 40 years. The increase in production has been accompanied by declining fertility, increasing incidence of health problems, and declining longevity in modern dairy cows. Genetic selection for increased milk yield is increasingly viewed as increasing profit at the expense of reducing animal welfare. The welfare problems should be addressed before there is widespread condemnation of breeding and management practices. A sustainable breeding goal aimed at improving fitness and tolerance to metabolic stress is recommended.