Advanced care planning and end-of-life decision making are part of contemporary debates about death and dying. A data-mining study reviewing medical records of patient deaths in hospital investigated these issues and the utilisation of social work services. Findings indicated that the majority of records included some form of documentation about end-of-life care, including cardio pulmonary resuscitation (CPR) orders and that family members and surrogate decision makers were more likely to be consulted than patients about these plans. The incidence of referrals to social workers was found to be highest ‘‘out-of-hours’’. Key social work interventions were identified, including establishing the reliability of surrogates’ decisions through social work assessment. This paper discusses elements that contribute to a supportive environment for patients and family members to facilitate the decision making process, including the need for a broader ethical discourse to accommodate the increasing complexity of end-of-life decision making in hospital settings.