Palliative care is not just for dying patients. In fact, dying patients are living patients, and all patients deserve palliation. Contrary to popular belief among many patients and clinicians, palliative interventions can be invasive and include not only medical, but surgical care. In any case, palliative care should be defined by intention: partnering clinicians, patients, and their loved ones aim neither to cure disease nor to prolong life, but to improve the quality of a patient’s life at any needed time. Quality of life is motivated by goal-elucidating conversation, counseling, and symptom management-directed intervention. This issue investigates surgical palliation specifically, with sharp focus on intention formation and trust preservation.