We believe that the time is right to assert the ethical imperatives of a healthy paternalism in discussions regarding advance directives with patients with cancer. Given the widely held perception that the principle of autonomy requires withholding prognostication and advice during discussions on advance directives, additional research and educational interventions among physicians in training and practice are required to address this issue, which has major implications for both quality of care and cost-effectiveness. In these vital conversations with patients, a studied neutrality regarding outcomes of CPR should not be an option. Oncologists must lead the way in this regard and document these discussions in the medical record for the benefit of all medical caregivers. The false dichotomy between healthy paternalism and patient autonomy should be abandoned on ethical premises and in the interest of patients and society.