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Hospice referrals continue to occur late in the dying process. Palliative care and Portable Orders for Life-Sustaining Treatment (POLST) goals of care endeavor to achieve earlier hospice referral. The patient’s desire for greater control drives a focus on controversial access to physician aided death (PAD) and voluntarily stopping eating and drinking (VSED). Case managers in a variety of settings should encourage patients and their family members to explore and consider care options before the time for having the conversation has passed. Dying patients and their families deserve an honest review of the medical, legal, and emotional resources to make this possible. The professional case manager is in a unique position to facilitate these discussions and ensure that the patient and family are able to spend their last days together according to their wishes.