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, depression/anxiety, and decision making at the end of life. 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 suggests 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 the unique 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 terminal pediatric patients. Cases on how COVID-19 impacts care at the end of life will also be discussed. Finally, a framework on how to approach terminal patients will be shared as a practical take-away for improving care at the bedside.