Background Although the benefits of Advance Care Planning (ACP) and of communication about End-Of-Life-Decisions (EOL-D) appear significant and conclusive, widespread adaptation is still lacking. A number of reasons for this have been discussed, including patients’ apparent refusal to talk about the end of their life.

Aim To examine whether there is an ethical obligation for physicians to lead conversations about EOL-D – even if some patients do not wish to talk.

Methods Initially, we extracted items concerning 254 cancer patients’ desire for, experience of and acting upon autonomy from our study „Advance Care Planning – Conversations about End-of-Life Decisions”. We subsequently analysed these findings from a bioethical point of view.

Results We found significant discrepancy between self-reported desire for autonomy in patients and the concurrent non-exercising of instruments of (anticipated) autonomy.

Discussion Such apparent contradiction between desire for autonomy and non-exercising of its possibilities could be deemed un-authentic under the conditions of “personal autonomy”. This might prima facie justify obligatory conversations about EOL-D for the sake of a patient’s real volition – a highly questionable proposal in severable respects.

Conclusion To solve this dilemma, we need to analyse the concept of “personal autonomy” further and apply the idea of “having a right to ignorance” and the approaches towards other seemingly “irrational” patient’s decisions on the given situation. We conclude that a physician’s obligation canindeed be put up here, but it is distinctly different from the one in question. This way we can come to a solution which likewise respects autonomy and beneficence.