All cancer treatment should be guided by patient values. These values can be ascertained either through dialogue about treatment modalities, interventions and their consequences, or through the expressed wishes of patients or their surrogates. A balance should be struck between always following patient wishes and traditional health care paternalism, whereby patients have had little or no say about their treatment. The best way to strike this balance is through advanced directives and intensive dialogue with the patient or surrogates about the patient's values throughout the course of treatment. In this way, the care of the cancer patient can become a truly fiduciary responsibility. Health care providers can salvage their traditional obligation to preserve life through a commitment to the preservation of the meaning of the patient's life. Conflicts about treatment are difficult to resolve, but a mechanism does exist for making ethical decisions. Institutions should support such mechanisms and guarantee the protection of the conscience of all individuals caring for patients, with the right to withdraw without prejudice to one's job, and without abandoning the patient.