This chapter considers an ethical framework to guide decision making to explore frequently encountered obstacles. It offers practical suggestions to enhance care for patients dying in the intensive care unit (ICU). To this effect, the chapter presents a case study of an 88-year-old woman with a history of diabetes, stable coronary artery disease, and hypertension, where there was consensus to switch the focus to palliation. Four basic ethical principles should guide end-of-life decision-making in the ICU: respect for the patient's autonomy; the duty of beneficence; the duty of nonmaleficence; and the obligation to ensure just distribution of care. End-of-life care, particularly making decisions to withhold or withdraw life support, is a fundamental component of critical care practice. Appropriate end-of-life decision-making hinges on the intensivist's understanding of key ethical principles. Careful, deliberate, and empathic explanations and negotiation usually lead to choices acceptable to both family members and the medical team.