Medical bills are the biggest cause (62%) of personal bankruptcies in the US, despite 78% of filers having medical insurance at the start of their illness, including 60% with private coverage. The resulting quality of life (QoL) impairment resulting from such financial hardship for these patients and their families is substantial. End-of-life care spending in the US is significant, 30% of all Medicare expenditures have been attributed to the 5% of patients that die each year, with one-third occurring in the last month of life. This is at least partially driven by an end-of-life treatment philosophy that has been characterized as “more is better” coupled with a “never say die” attitude. Oncology drugs are a large and increasing driver of such spending, accounting for $37 billion in US in 2013. Many such drugs typically provide only modest, if any, overall survival benefit with potential substantial associated toxicities. The average cost of branded cancer drugs has now reached $10,000 per month. As costs continue to rise, we question whether if health systems provided patients the option of a monetary pay-out instead of their candidate treatment, could they potentially provide better patient outcomes in terms of quality of life improvement through greater familial financial security or funding other procurements (a once in a lifetime holiday, a children’s college fund, or a high performance car)? Such an approach could also offer potential cost-savings to payers, better empower patients in their healthcare choices, and introduce a new factor putting downward pressure on drug prices. Nevertheless, even if this were true any such system would be fraught with ethical pitfalls, such as the pressure for patients to provide familial monetary support, perverse incentives regarding health promotion, and greater divisions in access to new treatments based upon wealth.