This is the second in a series of two articles on improving end of life care for terminally ill patients in a medical assessment unit. Through joint working between staff in a district general hospital and staff at a hospice, a new service was developed offering patients who are at the end of life and being cared for in the medical assessment unit the opportunity to be transferred to the hospice for palliative care instead of acute interventions. This article uses an ethical framework to examine the ethical, legal and practical considerations involved in developing the new service.