In this essay, important factors affecting decision-making in the care of cancer patients are identified and discussed in the face of actual socio-economic changes. The article is based upon a book chapter in German describing recent changes in Germany and other European countries and it expresses personal opinions that can be used as a basis for further discussions. The fundamentally altered practical framework of patient-care in oncology, its ethical dimension and practical significance are elucidated. These changes have profound influence on patient-doctor communication and have to be taken into account in the education of medical students in this area of their future profession. This is especially true in the confrontation with eternal questions about the finitude of life and how to find a good ending with the most recent developments in medical oncology that force patients to make decisions on how they want to be treated. In this context, the ethical dimension of the patient-doctor dialogue is presented and a proposal is made to adapt the classical "shared decisionmaking concept" to a guided decision-making model.