This paper examines the question of why patients decline treatment for cancer. Though small in number, patients with cancer who refuse treatment pose a problem for physicians and other health professionals managing their care. From the medical perspective such a decision appears irrational, and research has been conducted to try to identify features of patients and their situation that predispose this outcome. Research has also examined communication strategies used by doctors to influence patient decision making. The identification of these features supports an individualist perspective on this issue, even in the literature that seeks to comprehend the patient's point of view. Making use of a narrative perspective involving illustrative cases drawn from published research, this paper proposes that such decisions need to be understood in terms of patients' relationship to medicine, something that is changing with respect to medicine's weakened authority and the growth of a consumerist ethos. Second, the emergence in society of competing ideologies provides the possibility for alternative value sets in which the meaning of life can be assessed. This means that what seems an individual act of defiance is actually one of the highest social degree. To see treatment refusal in this way has implications for the mismatch between professional and patient preferences.