In this insightful discussion, Janis Miyasaki, a neurology division director and palliative care advocate, shares her journey and the importance of patient-centered approaches in integrating palliative care into neurology. Miranda Wan, a stroke fellow, reveals barriers neurologists face in conversations about palliative care, emphasizing cultural and training deficiencies. Carolyn Reynolds, a palliative care physician, examines the motivations of ALS patients considering medical aid in dying, highlighting emotional suffering and the critical role of caregivers. This dialogue sparks vital reflections on compassionate end-of-life care.