Numerous issues confront emergency physicians regarding end-of-life care in the emergency department (ED). Principles of bioethics can be helpful in developing a framework for the analysis and conclusions of ethical dilemmas. Some of the important issues and dilemmas frequently encountered in emergency medicine include issues surrounding resuscitation and resuscitation attempts, palliative care, symptom resolution, honoring advance directives and patient preferences, religious preferences, and spiritual beliefs. Effective communication and support techniques, including establishing the patient’s wishes, goals, and values of medical treatment can be beneficial in carrying out those wishes. In many cases, definitive curative care is not possible or is not desired, and the goals of medical care at the end of life shift away from technologic care to measures that provide comfort and support to the patient and family.