Every day people make choices on how to live. These choices are made in harmony with every individual’s unique life circumstances. Advances in medical technology and knowledge now provide people the choice of how, when, and where to die. As people continue to live longer, more and more individuals will have the opportunity to make end of life decisions. The purpose of this paper is to describe end of life decision making. Specifically, this paper will explore the cultural, financial, legal, and spiritual influences that impact the decision making process. Barriers associated with end of life decision making will also be reviewed. Social workers have an ethical responsibility to assist individuals, families, and other disciplines in making end of life decisions that respect and reflect the uniqueness of the individual served.