The document discusses the case of 87-year-old Hannah who is experiencing chest pain and is a candidate for bypass surgery. Her doctor, Dr. Nicely, is hesitant to perform the surgery due to the risks given her age and medical conditions. Hannah wants to go ahead with the surgery to address her chest pain, even if it carries risks of not surviving the operation. The document considers whether Dr. Nicely should perform the surgery and whether the costs to Hannah's HMO should be a factor in that decision.