The role of the cycloxygenase-2 selective NSAIDs in palliative care has not been studied, per se, but the improved adverse gastrointestinal and platelet effect profiles of these newer agents over nonselective NSAIDs offers potential advantages in patients with advanced disease. These issues are discussed. The need for greater emphasis on scientific and evidence-based approaches to palliative care is great and generally recognized in the clinical and scientific communities. Recent legal opinions about aggressive care of patients approaching end of life has increased this need. The clinical and ethical implications of these decisions are discussed.