Empirical research documents communication difficulties and practices which have contributed to clients' wishes and directives regarding end of life decisions being ignored, resulting in prolonged, painful deaths in hospital intensive care costs. Hospice decisions are complex end of life ethical decisions primarily because they are centered around client autonomy and the individual's right to choose to refuse treatment or to discontinue treatment. With documentation of the benefits of Hospice and palliative care, and overall client and family satisfaction reported in the literature, one has to question why more patients are not referred to Hospice, and why those who have been referred were done so at such a late date. A suggested model for analyzing end of life ethical decision making and contributing factors will be presented. It is a sociological, interactional model that will assist in identifying 'learned potential motivators' on the part of the client and the health care professional which can influence these individuals during decision making interactions and which can contribute to the 'rightness' or 'wrongness' of end of life decisions.