Medical spending is highly concentrated at the end of life and varies widely across patients, raising a first-order welfare question about whether marginal end-of-life spending reflects waste or generates meaningful benefits. Using Austrian administrative data, we document that end-of-life spending has grown markedly over time and remains highly dispersed even conditional on diagnosis, with predicted mortality explaining only a small share of the variation. We then study a largely underexplored margin: spillovers onto surviving spouses. Event study estimates show large and persistent changes in spouses’ employment and healthcare use around spousal death. However, these dynamics are essentially invariant to the decedent’s end-of-life spending intensity, a finding that is robust to different measures of spending intensity and to an instrumental variables design exploiting provider-level practice variation. Together, these results are consistent with an important role for inefficiencies in end-of-life care.