Table 2. How seniors decide between surgery and palliative care.

Decision Construct	Underlying reasoning	Quotes
Life or death	Imperative to choose life Guilt/disappoint others Only God decides life and death Cannot explicitly choose death	“I didn't have the right morally to decline the surgery.” “Go ahead and have the surgery and get it, put it in the hands of the man that is going to take care of you.” “It all depends how much you want to live. Do you want to get well? Have faith in God and your doctor.”
	It's better to die trying It's painless to die in the operating room Demonstrates intent to live Death in surgery is okay because it is controlled by someone else(surgeon/God)	“She had a lot of stuff, but, you know, a lot of … but I felt that if I make a decision, and she would pass while they were doing the surgery, at least I took the initiative of, you know, giving her that chance.” “it's important and necessary that you should get the surgery. It might not turn out the best, but it's better for you if you do have the surgery.” “I mean, two days, it's going to break. I would say, well, give me the operation, and if I live, I live. I mean, to me, there's no choice.”
	Life is better than stated Disbelief about outcomes/options Surgeon is wrong/misinformed Surgery might be “successful”	“First question is, well, let's see, if I reduce the blood pressure, or is there something you could do to strengthen that piece of artery or something?” “But we all know that miracles can happen.” “I might like to have some examples of when [surgery] has been a successful… That in some cases, a surgery goes very well, and you can resume almost a normal life.”
How to die	Death is the outcome of surgery and supportive care Death now or death later Surgery will prolong dying	“And it's when you die, or in this one, you die… You just die sooner or later.” “and even in here, you know, either/or, they're telling her, you're going to die either way. It's just that one will take right away, and the other one, it would be prolonged.”
	Desire to control how death occurs To be with family Pain controlled Peacefully	“I don't want to deal with a nursing home or be unable to do stuff by myself, so I'd rather just go on and not suffer anymore. I'd rather go in peace, say bye to my family, let all them gather.” “I'm going to die anyway, so I'd rather say goodbye to my family and just give me pain control so I could, as much as they could control the pain, and I know I'm fitting to go, so I'd tell [family] bye.”