Ethical end-of-life decisions do more than prolong or terminate a life. These ethical decisions may haunt survivors long after the death occurs. They may complicate grief, creating family dissension, inhibiting support and increasing ambivalence over the nature or circumstances of the death. Conversely, end-of-life decisions may not always be negative. In other circumstances, they may facilitate the grief process, allowing survivors a meaningful end to the story of a loved one, providing survivors a modicum of control that ends a person's pain, following the deceased wishes, or simply seeming to survivors to be the right thing to do. This article explores the ways that end-of-life decisions influence grief, offering suggestions on factors that might mitigate problematic outcomes.