WHO defines palliative care as an approach that improves the quality of life of patients. The most common reasons for ICU admission are respiratory failure, acute myocardial infarction, intracranial hemorrhage or ischemic stroke, percutaneous cardiovascular procedures, and sepsis. In these situations, mechanical ventilation is the most commonly used life-sustaining intervention. These patients are at high risk of death and have an uncertain immediate prognosis. Providing access to palliative care in these cases allows the patient’s and family’s preferences regarding prognosis to become clear, so that the care provided can be aligned with their desires. In end-of-life situations, the goal of care can be reviewed and, if the goal changes from cure to comfort, artificial life-sustaining measures deemed inappropriate can be withheld and symptom control can be prioritized. Compassionate extubation is the process of withdrawing mechanical ventilation when the goals of patient care have become comfort as the absolute and exclusive priority. The procedure involves a high degree of complexity in terms of communication with the family member and, if possible, the patient, the need for experience with mechanical ventilation, and intensive management and control of symptoms that may occur during the procedure. A technically rigorous execution will reduce stress for patients and families, as well as misunderstandings, discomfort, and additional suffering for all involved in the process. The goal of palliative care and compassionate extubation is always orthothanasia, so it is important to emphasize that withdrawing life support is not withdrawing care, as will be discussed.