As physicians our goals are to practice beneficence and non-maleficence. When it comes to patients facing terminal or unrecoverable illnesses or those at high risk for morbid outcomes following treatment, the best path to these goals becomes less clear. There is a lack of professional practice standards for physicians to follow in these difficult clinical and ethical scenarios. Through collective experience and expertise this program hopes to provide ethical guidance for surgical decision making. Panel will include case examples, direction on how to balance surgical outcomes and patient quality of life and provide tools and resources for informed and shared decision making by all parties.