Defining typical appearance as a goal of health service provision is harmful and unnecessary for traits that are stigmatized but neither harmful nor distressing.

No single person should make decisions about for whom or according to which criteria palliative surgery is clinically and ethically appropriate.

Differentiating between best palliative care options and the curative and palliative potential of surgery is key to developing dual intentional clarity.

When surgical intervention is most appropriate, success should be defined by how well a surgical intervention aligns with a patient’s goals.

For some patients whose survival is extended by disease-modifying interventions, little guidance about clinical and ethical complexities exist.

Word usage and intentional clarity will influence how patients feel about that Whipple pancreaticoduodenectomy surgery.

Calls to expand palliative care education have been explicit since the 1990s, but palliative care training in surgery remains too narrowly focused on end of life.

Priorities far beyond generating morbidity or mortality data are needed to improve patients’ experiences, innovate metrics, and advance surgical palliation as a field.

Guidance about sedation to unconsciousness and medically ineffective interventions can be applied to surgical palliation.

Seeming incongruity between surgery and palliation reiterates patients’ needs for clinicians to be able to identify when and how they should coexist.