This study is a cross-sectional descriptive survey of randomly selected primary care patients and physicians regarding patient, physician, and family roles in end-of-life decision making. The subjects included 329 adult outpatients and 272 practicing physicians. Physicians were more likely than patients to believe the patient alone was responsible for making end-of-life decisions. Patients were more likely than physicians to believe the physician should provide a recommendation in addition to facts to help the patient make end-of-life decisions. We conclude that patients prefer a more active role for physicians in both decision making and discussion of end-of-life care than do physicians themselves.