End of life communication is central to the work of palliative care professionals—yet such communication is hardly easy or straightforward. Drawing upon anthropological research I conducted with Israeli palliative and hospice care professionals, I explore how end of life communication is enacted in the local world of Israeli palliative care. I argue that Israeli palliative care professionals face numerous communication challenges which stem from the complexity of end of life care. For example, professionals routinely encounter situations in which the communication preferences of patients and family members are in conflict, forcing them to choose between the best interests of patients and family members. Each professional must rely on their own best judgement when navigating such challenges. The divergent communication policies they adopt reveal the competing ethical demands of end of life care.