Abstract: Hospice nurses in New Zealand provide supportive care to patients of settings. In doing so, the hospice nurse and team are likely to have an ideal of a “good death” that guides their practice.A 'good death“ is one where symptons are well controlled without over medicalisation, where there is an acceptance of death by the patient and loved ones and where appropriatepreparation and completion of unfinished business has occurred. The death itself is peaceful and the loved ones are present. However, patients or their families do not always accept the treatment or care that the nurses offer to facilitate the best quality of life and a ”good death“ for the patient. This may leave the nurses involved feeling distressed and confused, as they are confronted with the conflict between the patients' path and the nurses' ideals.This study employs critical incident technique to explore how nurses respond and feel when the patients decline the treatment or care the nurse feels will improve their quality of life and eventually lead to a ”good death“. The findings illustrate a broad range of treatment or care that is declined by either patients or their families in the first instance. This study uncovers a number of action responses nurses use in these situations, which demonstrate acceptance of patient choice but also need to help the patient experience a ”good death". In addition it demonstrates that nurses experience a gamut of emotional responses to such situations, some of which are painful for the nurse and have the potential to cause stress. Recommendations are made which may assist nurses limit the distress they experience when patients of their families decline the treatment or care, and empower nurses with further strategies to use in such situations