This review considers some of the difficulties associated with quality assurance in the context of palliative care. In particular, it will focus on the key question of who should be responsible for assessing quality and the problems of over‐reliance on one particular perspective. Problems encountered in formulating criteria, setting standards and developing outcome measures, many of which are exacerbated in the palliative care setting, are discussed. A review of some of the methods currently available for assessing quality and their limitations are delineated. Finally, attention is drawn to some of the practical and methodological difficulties currently confronting palliative care with regard to quality assuranc