Introduction One essential element in shared decision making practice is that the decision is made on patients’ preferences. However, vulnerable cancer patients may not involve in the decision making process. Surrogates will make treatment decisions for them.

Objective This study aims to explore how physicians respect patients’ rights when they are absent in treatment decision making and how physicians evaluate the rightness of surrogates to present patients’ preferences.

Methods 20 oncological physicians from a hospital in China were interviewed to describe the shared decision making practices in which cancer patients were not involved.

Results Physicians respect patients’ rights by: 1) Strategically responding to their inquiries about the diagnosis and disease; 2) Prioritizing the well-being of patients during communication; 3) Considering patients’ unique contexts when involving family members to make treatment decisions.

Physicians evaluate the rightness of surrogates by a coherent narrative synthesized by: 1) The contextual information of family and living conditions; 2) Interactions between the patient and family members; 3) Direct dialogues with patients and their surrogates.

Discussion From individual autonomy to relational autonomy, shared decision making evolves from ‘empty ethics’ in the traditional bioethics model into ‘bonded ethics’.

Conclusion When the patient is absent, patients’ rights and rightness of surrogates create the tension in reaching treatment decision based on patients’ preferences. One solution of this ethical tension is to synthesize multiple narratives of patients’ preferences from all the stakeholders.

Type of submission Oral or poster sessions.