This article argues that caregivers have an ethical duty to ensure that shared decision making and palliative care measures are fully discussed with and understood by their advanced heart failure patients. This is not a trivial issue. Heart failure is reaching epidemic proportions, while advances in treatment options available for heart failure patients have made it possible to prolong the life of many patients. The potential benefits and burdens of available treatments must be clearly understood by the heart failure patient so the patient can make decisions consistent with his or her values and wishes. However, too often patients are not given full information about how such treatments will affect their quality of life or about appropriate palliative care measures. The solution to this problem requires shared decision-making about treatments and palliative care measures to ensure proper goal setting, reevaluation with changes in prognosis, and end of life preparedness planning.