10% of patients admitted to ICU die and, in some societies over 80% of people die during a hospitalization that included an ICU stay. Most deaths in ICU are predictable and the overwhelming majority of patients are comatose for the last few days of their life. Most communication by intensivists is directed at families rather than patients. This talk will cover some scenarios where this isn't the case and give guidance on delivering bad news to and discussing organ donation with awake patients.