The issues surrounding end-of-life and medical “futility” are often very challenging, and when confounded with misunderstandings about the difference between withholding or withdrawing certain treatments, while never withholding care, these issues can easily prompt confusion and conflict. When combined with the complexities of social dynamics and cultural differences, sorting through the issue of medical “futility” or even more general end-of-life issues can prove to be daunting. Sensitivity and awareness of the intricacies of this issue are important to resolving conflict when it arises. This chapter highlights some of these intricacies and presents steps and methods for working through the issues. The suggestions provided here will not serve as a cure-all. Instead, they represent strategies that have been employed in our practice and may prove useful in other settings. The most important point to note is that end-of-life concerns are often ameliorated when caring clinicians work respectfully and firmly with families and surrogate decision-makers in doing what is best for the patient using compassion, communication, and collegial co-management.