Palliative care has been shown to improve outcomes for patients in the intensive care unit (ICU), particularly in improving symptom control and satisfaction with care plans. Beauchamp and Childress are credited with a widely used approach to ethical issues known as principlism or the 4-principle approach, whereby each of the benefits in a situation is evaluated. Their approach focuses on consideration of beneficence, nonmaleficence, respect for the patient’s autonomy, and an evaluation of issues of justice in how care is provided. Under the more sustainable combined model, primary palliative care such as basic management of symptoms along with discussions regarding values, goals, preferences, and prognosis are expectations of the primary cardiovascular ICU (CICU) team. The CICU can be a bewildering and frightening place for both patients and their loved ones. Many families have never experienced a critically ill family member, and the initial interaction with their loved one who appears entangled in tubes and catheters can be unsettling.