Otolaryngologists often care for patients at the end of their life, but are rarely comfortable with switching from curative treatment to a palliative treatment paradigm. In addition, otolaryngologists are often uncomfortable treating common conditions that arise in this patient population, including chronic pain, and depression/anxiety. Discussions surrounding end of life issues often arise in residency, but current residency education models provide little formal education on how to approach patients at the end of life. Recent evidence suggest that only about 5% of terminal Otolaryngology patients receive palliative care consultation, indicating an opportunity for quality improvement in this setting. This session will describe the most current research on end of life care, and discuss how the principles of palliative care can be applied to patients to improve the quality of care Otolaryngologists provide. Foundational ethical principles of autonomy, beneficence, non-maleficence and justice will be described so that surgeons have tools to approach difficult patient encounters. A case based approach will be used to illustrate how Otolaryngologists experienced with treating terminal patients approach patient care in this situation. Cases will be used as a springboard to discuss important considerations for otolaryngology patients at the end of life, such as disfigurement, communication difficulties and dysphagia in head and neck cancer and issues of substituted judgement in pediatric patients. The COVID-19 pandemic will also be addressed, especially situations where Otolaryngologists are asked to perform tracheostomy in COVID-19 positive patients. Finally, a framework on how to approach terminal patients will be shared as a practical take-away for improving care at the bedside.