I have been working for several years in a variety of nursing homes, providing psychotherapy to people, who, in one way or another are facing the end of their lives. This has been one of the most difficult and rewarding professional and life experiences I have ever had. I have learned that the closer we get to taking our own demises seriously the more we confront a decision to either give up on life and merely exist or live as if every second is precious and should be lived to the fullest regardless of life circumstances. Tonight I will discuss some of the reasons people opt to exist while others retain their deisre to live. These factors include family support, religious beliefs, unresolved guilt, shame and other conflicts as well as the presence or absence of a deepseated belief that personal choice is always available and that we are the sole owners of our own life. I will discuss my role as a professional in dealing with people suffering existential depression and feelings of meaninglessness as they live out their final time in nursing home facilities.