This paper begins by considering some of the principles on which clinical practice is traditionally based. Hospice care & the principles of this care, i.e. treating the patient as a person, symptom control, & the care of the relatives is discussed next. The third section of the paper discusses improving standards of care for the dying. The final part of this paper presents a manifesto for improvement in the care of patients with incurable cancer. An extensive commentary & a response to the commentary conclude the paper.