When does treatment outweigh the benefit? Why is it that physicians find it difficult to discuss palliative and end of life care? Is it that they don’t want to be the bearer of bad news or they feel an obligation to continue treatment until treatments no longer have any individual or research benefits? My brother, at age 55, diagnosed with leukemia went through eight months of treatment, some experimental for the hope that his experience could benefit the lives of others. He died at home with hospice care, only days after stopping treatment. The last several months of his life did not need to be lived in misery, but his physician was more motivated to do research than to promote pain free quality time with his family. On the other hand, my brother’s hero was John Wayne; I can see why he went out the way he did, fighting until his very last breath.