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Qualitative interview data concerning patients' decision making in major surgery (total colectomy and ileostomy) are reported. Unsurprisingly, these procedures are not recommended lightly by the medical profession and the medical and surgical consensus is that patients should be involved in the decision making which leads to the surgery. Data relating to that involvement are presented. It is argued that the decision making is a process which involves changes in identity and self and that the tensions between identity and self account for some of the emotional and other problems attaching thereto.