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I like thinking about choice. It is an interesting concept and can involve logical, rational thinking and irrational and illogical thought — sometimes concurrently. Choice is not just a human phenomena. Animals make choices, some deliberate and some random. But when all is said and done, a choice is a decision that has an outcome (or consequence). When we make rational choices, we are said to be informed of the consequences. Irrational choices are those where consequences don’t matter. To digress for just a moment, consider the age-old saying involving cake. It is generally cast as a statement of choice that resolves to a consequence: if you eat your cake, you can’t have it. Think about the statement for a moment. If I truly want to possess a cake, I can’t eat it. Both are desirable: having a cake is nice, eating it is better. But, the consequence of eating involves the loss of cake and, for example, a further consequence if one planned to use the cake to celebrate a child’s birthday. Most would characterize eating this presentation cake as irrational. Disappointment is the consequence and it is known and understood before making the choice to eat. Let’s extend our thought experiment to a choice between lung cancer treatment and continued smoking. Surgery, radiation and chemotherapy all irritate the lung, and presume the smoker realizes that tobacco smoke (indeed any smoke) is also a lung irritant. Choosing smoking under these circumstances is irrational. The known consequences range from healing problems, surgical failure, and premature reoccurrence. Yet these don’t seem matter. The impact of consequences will also disappoint the treatment team and family who are praying and hoping for success. There are many choices in lung cancer, all with consequences. Not choosing treatment because disease is at an advanced stage is rational. Implicit is the forbearance of side effects with little prospect of success but yielding a higher quality of end-time life. But when one chooses treatment, one is choosing life extension. Choosing also to continue smoking while undergoing treatment is not rational and puts at risk the opportunity for extended life. Let’s make rational behavior choices and avoid undesirable and disappointing consequences. Chose either to have your cake or eat it. Stay the course.