Advances in medical science and technology offer new medical interventions at the end of life. These new medical measures create new ethical issues, which increase in complexity in a multicultural society. This paper discusses three cases, in which cultural value systems play a decisive role. Change in the goals of therapy, truth telling of diagnosis and prognosis and presumed will of the patient are the key ethical points in these cases. Because of growth in minority populations in Germany, it is foreseeable that the number of these issues will increase in the near future. The author of this paper argues that concepts and measurements must be urgently developed in health care systems to help the medical staff in their daily practises. According to him, cultural competence and cultural sensitive advanced directives can be helpful for solving complex ethical problems at the end of life. Other interventions and measurements were also described for improved end-of-life care in multicultural setting.