But what happens when physicians' criteria don't align with the priorities of a patient?
Take this hypothetical example: you wake up with a dozen marble-sized tumors in your brain. A combination of BRAF and PD-1 inhibitors has a small chance of curing you. This is backed by science, this is already a known result. Without the treatment you are dead within six months. With the treatment, you have a small chance of being cured.
However, due to potential known complications of PD-1, it is not yet approved as first-line for patients with brain mets. So the doctor says you must first go through whole brain radiation.
Your oncologist's only goal is to extend your life, he doesn't care about what you value and what kind of life you want. Therefore WBR and then immune therapy is the logical choice.
But maybe you don't just care about not dying, maybe you expect a certain quality of life and are willing to take the risk of foregoing whole brain radiation, because life after whole brain radiation is not a life you'd want to live.
What right does anyone have to tell you you are not allowed to take that risk?
These pure theoretical reasons for not giving patients the right to choose are so far removed for the day-to-day reality of someone dying of cancer, it's ridiculous. We're not dealing with abstract data with the goal of reaching some life-expectancy maxima using one-size-fits all treatment. We're dealing with people who have different priorities, and maybe care about more than optimizing for the treatment that is statistically most likely to squeeze an extra month of existence out of them.