In January 2009, NICE began a policy for valuing the use of drugs for extending life in people with a short life-expectancy. This development arose from concerns that NICE had been denying patients life-extending treatments because they were too expensive. However, the new policy also raises important ethical and moral dilemmas. In this podcast Dr Martin Duerden, General Practitioner and member of the DTB editorial board, and Dr Ike Iheanacho, DTB Editor, discuss this policy and the issues it raises. This is an extension of our June 2009 Editorial, Real costs of end-of-life drugs DTB 2009; 47: 61.