Previous research on end-of-life communication in families has largely considered whether family members have talked about end-of-life healthcare (quantity of talk) but not whether certain characteristics of that discourse matter (quality of talk). In the current study, the authors adopted a multiple goals theoretical perspective to examine discursive features that individuals use to manage goal dilemmas in family conversations about end-of-life health choices. Discourse analysis of end-of-life conversations between 121 older adults and their adult children showed that participants attended to relevant task, identity, and relational goals in ways that affirmed or threatened these goals, and the ways in which certain goals were accomplished had implications for how (and whether) other goals were pursued. Findings suggest that end-of-life talk in families is most effective when family members are able to address the task of discussing end-of-life decisions while also attending to the relevant identity and relational implications of such conversations.