Choices of curative and palliative care for cancer patients.

Decision-making in cancer treatment is a complex art that requires specific attention by the physician who is principally responsible for the patient. Whenever possible, the aim should be to advance the patient's interests as the patient defines them. To achieve this, the patient must understand the situation and the likely outcomes of treatment options that might be of benefit, must be free of coercion and manipulation and capable of self-determination, and must be capable of reasoning. When a patient cannot collaborate in the decision-making, the physician needs to recognize this and a surrogate should be chosen to speak on the patient's behalf. The range of treatment options must not be unduly narrowed by lack of consideration, incorrect understanding of the governing moral and legal prohibitions, or unreflective use of imprecise categories.