1. End of life ethical decision-making is complex and involves many key players, each with their individual roles, responsibilities, and ethical concepts. 2. Each long-term care ethical decision which presents itself involves alternatives and choices. These must be thoughtfully evaluated to reach the best decision possible. 3. Those involved in ethical decision-making are influenced by various ethical theories as well as factors including control, legal issues, failure, coercion, obligation, advocacy, autonomy, respect, and cost. 4. Ethics committees can play a valuable role in assisting patients, families and staff through the decision-making process by providing guidelines based on ethical principles and compatible with facility mission and philosophy.