Decision-making in surgical practice is a highly complex interaction between the client (patient) and his or her professional advisor (surgeon). The client approaches the professional advisor full of expectations and fears. The expectations may be realistic or unrealistic, and, in the same way, the fears may be justified or unjustified. Furthermore, the client may have a variety of priorities not immediately apparent to the surgeon and may wish to express different degrees of autonomy. For example, some patients may demand the final say in determining the balance between length and quality of survival, whereas others would be happy to allow complete abrogation of their responsibilities to the surgeon, who is invited to make the difficult decisions concerning the patient's utilities. From the viewpoint of the surgeon, the transaction is equally complex, and his or her decisions may be constrained by resource allocation and time available. However, in the final analysis, assuming a beneficent doctor, the most appropriate decision will be determined by the weight of evidence that can be adduced in favor of any intervention.