Difficult ethical problems are often faced by patients, families, and social workers who assist in decision-making around issues regarding end-of-life care. In qualitative interviews with 12 hospital social workers in one large urban cancer center, common ethical issues identified through thematic analysis were preservation of patients' autonomy/self-determination, beneficence of health care providers, and medical futility of end-of-life treatments. Continued communication with all parties involved was key in resolving ethical problems. Discussion, along with referrals of more complex cases to ethics committees and ethics consultation teams, also occurred. Participants further indicated the potential helpfulness of developing practice guidelines for social workers dealing with decision making about end-of-life care.