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This case study illustrates the complex role that a physician’s conscience can play in end-of-life care. We examine a case in which a terminally ill Vermont patient requests aid-in-dying from her primary care physician under Vermont’s “Patient Choice and Control at End of Life” Act. The physician feels conflicted: she is opposed to prescribing death hastening-medication, but she does not want to abandon her patient, either. Much of the medical ethics literature on conscience focuses on whether healthcare professionals should be permitted to abstain from providing morally contested medical services. Our analysis highlights the interplay of conflicting values that inform the physician’s engagement with aid-in-dying, demonstrating that the issue is often more nuanced than the question of whether or not a physician can (or should) opt out.