Social workers in hospice and palliative care settings have been charged with the responsibility of addressing sexuality with their patients and families. However, little direction has been offered as to how to approach this difficult subject within the context of palliative care. This article provides a critical analysis of the previous literature on sexuality and terminal illness. The authors address systemic barriers, such as institutional policies that marginalize already vulnerable groups. Several recommendations are provided for social workers, including skills, core dimensions for assessment and intervention, and implications for interdisciplinary teamwork.