It can be very difficult to observe patients living out their health in less than healthy ways. Nurses are in the business to promote better health for their patients through patient education, community education, and modeling sound healthy behaviors. It can challenge a nurse's internal values when poor health practices are observed. Examples of this challenge occurred many times in my own career. Watching a dying patient gasp for each breath while begging me to allow him to smoke with his family caused me to question my sense of caring and ethical practice. Despite his extreme fatigue, Mr. Y. faintly smiled at me as I entered his room to begin my evening shift with his initial assessment. A 40 pack-year history of smoking and a lifetime manual job separating various types of sandstone at a stone quarry contributed to his chronic lung disease. It was very difficult for me to reconcile that this terminally ill patient with chronic obstructive pulmonary disease (COPD) “had a need to smoke” during the few days prior to his death. His shallow breathing was increasingly difficult, his tissue perfusion was poor, and his pulse oximetry was in the 80s. I heard the wheezing with each breath and could see the struggle that was his constant companion. I walked closer to Mr. Y who was sitting in his bedside chair with his feet propped up on a stool. His large, edematous lower legs and ankles were taut and weeping. The soaked towels under his legs needed changed every 30 minutes. Frequently coughing and expectorating copious amounts of yellow-white mucous, Mr. Y. attempted to seize several moments of precious sleep whenever he could. His wife and three sons were present and provided comfort and compassion. Each family member remained with Mr. Y, except when they took their turn to smoke in the unit's lounge. This community hospital in a rural area of Virginia still permitted smoking in a designated solarium on the unit. Mr. Y's wife repeatedly stated that smoking was important to their family because it brought them together and they could share this activity. Mr. Y. motioned for me to come closer to him and said he was begging me to allow him to smoke and be happy. Should his wish for a cigarette support his sense of well-being? Should the professional nurse honor his wish over the unquestionable truth that smoking is clearly implicated in COPD and can increase symptoms in patients? Would one more cigarette contribute to a decreased life expectancy? Did he have a right to be wheeled to the smoking lounge to be with his family members who were taking their breaks and smoking? Should the nurse ignore his wishes? I was torn between this person's wish and believed “need” with my own nursing knowledge. The patient desired to live out his health in a manner that supported who he was and in a style that gave him a sense of well-being and comfort. In spite of his increased symptoms, he whispered that he experienced happiness by smoking, and this could not be provided by the nursing staff. Above all, nurses are patient advocates. Acutely aware of this, I spoke to Mr. Y's physician and clearly described the request. Mr. Y was permitted to be with his family in the unit's solarium to smoke. His countenance was beyond description during these last 2 days.