This paper is about decision making at the end of life which involves 3 areas of care: 1) shared decision making; 2) hospice care; & 3) shared governance in nursing. The purpose is to demonstrate that these processes have as their goal the relief of suffering as well as the consideration of patient vulnerability, the protection of third parties, & the preservation of the integrity of the medical profession. Most of the discussion involves the New Jersey experience, especially the Quinlan case.