Two studies presented at the recent STS Annual Meeting showed that surgical therapy is superior to alternative treatment approaches for both esophageal cancer and coronary artery disease in younger patients. In light of these findings, Robbin G. Cohen, MD, MMM, Mark S. Allen, MD, Sebron W. Harrison, MD, and Alan M. Speir, MD discuss why patients refuse surgery, how they respond to patients who opt against surgery, and the obligations of surgeons in an age of patient autonomy.