This article discusses ethical issues during end-of-life care in hospitals. The commonly used medical-ethics framework for ethical reasoning comprising of autonomy, beneficence, non-maleficence and justice is somewhat limited in guiding healthcare decisions. The continuing advancement in medical technology, current medico-legal environment, longer life-expectancies and increasing contextual awareness are some of the reasons why this ethical framework is limited. In addition to this, the high costs involved in end-of-life care make limit-setting decisions necessary. In order to be well received, these decisions need to meet the four conditions of accountability for reasonableness namely – publicity, relevancy, revision and appeal, and regulation. There are many stakeholders in decisions pertaining to end-of-life care besides the patient, with their own unique perspectives that complicate the situation. The article provides examples of ethical conflicts, the relevant stakeholders, factors that influence these unique perspectives and the potential for politicization of issues. The author touches on the subject of physician-aid-in- dying and concludes with a few recommendations for healthcare organizations to effectively deal with ethical issues during end-of-life care.