Hard Choices quest follows The Doctor Is Out. This is the last main story quest.
After all you have survived on the islands you have a final choice to make.
when you get to the temple you and Riley will head inside. You will notice strange things at the temple; there are no warriors and the gate is wide open. At the top of the stairs you demand answers from Citra about what is going on with your friends. As you look at a nearby warrior who took away Riley Citra will prepare another surprise. When you turn back she blows a strange powder in your face.The next scene takes you in front of the red temple entrance with Citra beside you. She explains why she did what she did and why you are here now. Soon enough she will go inside and after releasing from ropes you follow her.You will pass by many of Liza’s visions in the next scene. At the end of the path Citra will be waiting with the ancient knife. After you take it from her you find yourself holding it on Liza’s throat.
Make your destiny complete.
Make your final choice and accept the consequences of your actions.
You can read what each of the endings does by following these links