The practice of smoking ceremonies at end of life for Aboriginal people is steeped in cultural traditions. These practices can include smoking a person pre-death, as well as post-death, as a form of cleansing and to send off the spirit(s) to the Dreamtime. While there is anecdotal evidence that smoking ceremonies occur in hospitals in Western Sydney, the impact on Aboriginal communities has not been formally evaluated. This research aimed to investigate the cultural significance and impact of smoking ceremonies for providing culturally safe end-of-life care in a hospital setting. In doing so, the findings may inform the implementation of policy with appropriate cultural governance.