This is a topic that is hardly discussed in any forum in Sri Lanka whether scientific or non scientific. Even though doctors are not under stress to take end of life decisions in this country, time and again the intensive care clinicians have to face these dilemmas. Traditionally we do not discuss and accept different modalities of end of life decisions. Understanding key ethical and legal principles are important considerations for ICU practitioners when taking treatment decisions. Medical futility, respect for autonomy, justice, non- maleficence, advance directives or “living wills”, shared decision making are some of these ethical principals. ICU clinicians should neither take over nor accept the responsibility of end-of-life decisions without having the correct understanding of these.