Deaths occur frequently in the intensive care unit, yet clinicians in this unique practice environment are often untrained in the care of patients who are dying. Palliative care consultation in the intensive care unit may bridge the gaps between what should be done for dying patients and their families and what is often the default, that is, a prolonged death with inadequate symptom management and not enough family support. Hospital-based palliative care consult services have demonstrated positive patient-assessed and system outcomes, including symptom management, family support, reductions in hospital length of stay, increases in discharge home with hospice referrals, and reduced costs of care. Similar outcomes have been reported about intensive care unit-focused palliative care consultation. Palliative care consultants who seek referrals from the intensive care unit will be successful if strategies such as getting acquainted, learning about the environment and patterns of care, seeking feedback, and respecting the intensive care unit's life-saving efforts are employed. Intensive care staff satisfaction with palliative care consultation will drive future referrals.