Adolescents with end stage hip disease must decide whether to get a total hip replacement (THR) or a hip fusion procedure known as an arthrodesis. The decision is representative of many difficult medical decisions; the THR is better in the short-term but poses risks of wheelchair-reliance in middle age. Moreover, there is no single “best answer” to this problem given the heterogeneous tastes and circumstances of adolescent patients with end stage hip disease. Consumer sovereignty is the ordinary policy response to such heterogeneity, but even adolescents who are generally competent tend to be too myopic to make this decision prudently. Doctors should identify objective proxies for non-myopic tastes and either “nudge” patients towards acting on such tastes or inform them of the relevant proxies.