My friend is a respected oncologist at a prestigious American cancer centre where international patients come to seek his expertise. It’s uncommon for him to ask my counsel but I can tell he is troubled. Under his care in hospital is a young patient, the daughter of influential parents, diagnosed with incurable cancer. Experienced surgeons have deemed the cancer inoperable and the oncologist has admitted the patient for palliative care. The parents are devastated. Faced with the prospect of loss, they pledge to leave no stone unturned, and recall an early conversation mooting a liver transplant as the only potential cure. But transplants carry high morbidity and mortality and it had become apparent with time that this patient’s trajectory would not be altered by a transplant.