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In this paper, we look at decision support for post-operative breast cancer care. Our main concerns are to support autonomy of decision making whilst maintaining the governance and reliability of the decision-making process. We describe the context of our work in the wider medical setting. We then present a set of decision support tools based on the situation calculus as a means of maintaining the integrity of rule bases underlying the decision-making system. The decision support system, Neptune, allows for the authoring, maintenance and delivery of decisions in a self-governing framework. Finally we discuss the implications of our work.