The film stars John Wayne in his last film appearance before his death in 1979, Lauren Bacall, Ron Howard, James Stewart, Richard Boone, John Carradine, Scatman Crothers, Richard Lenz, Harry Morgan, Sheree North and Hugh O'Brian.

Hostetler prescribes laudanum for the pain but advises that his condition will eventually become unbearable, remarking that if he had Books's courage, the death he has just described is not one he would choose.

Books orders a headstone, but rejects the undertaker's offer of a free funeral, suspecting he would charge admission to view his remains.

Books asks Gillom to visit three men with violent reputations: Mike Sweeney, the aging outlaw brother of a man Books killed in self-defense; Jack Pulford, the Faro dealer at the Metropole saloon, a deadly crack shot; and Cobb, Gillom's boss.

Books gives Gillom his beloved horse, bids farewell to Bond, and then boards a trolley for the saloon.

Producer Mike Frankovich announced that he had purchased the movie rights to Glendon Swarthout's novel The Shootist, and Wayne expressed a strong desire to play the title role, reportedly because of similarities to the character Jimmy Ringo in The Gunfighter, a role that he had turned down 25 years earlier.

[5] Paul Newman passed on the role, as did George C. Scott, Charles Bronson, Gene Hackman, and Clint Eastwood, before it was finally offered to Wayne.

His compromised lung capacity made breathing and mobility difficult at Carson City's 4,600 ft (1,400 m) altitude, and production had to be shut down for a week while he recovered from influenza, but Wayne completed the filming without further significant medical issues.

[6] The Shootist was Wayne's final cinematic role, concluding a 50-year career that began during the silent film era in 1926.

He remained clinically cancer-free until early 1979, when metastases were discovered in his stomach, intestines, and spine; he died in June of that year.

It was a Paramount production, yet the street scenes and most interior shots were filmed at the Warner Bros. backlot and sound stages in Burbank, California.

[10] Wayne's contract gave him script approval, and he made a number of major and minor changes, including moving the location from El Paso to Carson City[11] and the ending.

He also objected to his character being killed by Gillom and suggested that the bartender do it, because "no one could ever take John Wayne in a fair fight".

Several friends and past co-stars were cast at his request, including Bacall, Stewart, Boone, and Carradine.

James Stewart had not worked in films for a number of years, due in part to a severe hearing impairment, but he accepted the role as a favor to Wayne.

Stewart and Wayne had worked together in two previous Westerns: The Man Who Shot Liberty Valance and How the West Was Won, both released in 1962.

While filming the sequence in the doctor's office, both Stewart and Wayne repeatedly muffed their lines over a long series of takes, until director Don Siegel finally pleaded with them to try harder.