Palliative care for the critically ill has become an increasingly important component of care in the SICU. As the population ages, medical technology continues to offer new treatments that can prolong life, and more and more Americans die in the hospital in critical care settings, the appropriate management of the end-of-life must be part of the clinical expertise of surgeons and intensivists. Part of this expertise must include the components of palliative care (eg, pain and symptom management, psychosocial support, communication skills, shared decision-making) and specialized areas of withdrawal and withholding of life support. Integrating palliative care expertise into the SICU is not straightforward; understanding when and how to make the transition from curative to palliative care can be fraught with uncertainty regarding prognosis and patient preferences. Attention to the principles of good pain management, communication with patient and family, and discussion of goals of care are not just for patients who are at the end-of-life, but are appropriate care for all critically ill patients, regardless of prognosis. In this framework, "intensive care"encompasses palliative and curative care.