The development of jaundice, ascites, or encephalopathy in the context of chronic liver disease or malignancy is an ominous indicator of advanced disease. In two studies of individuals admitted to hospital with jaundice, up to 42% of patients with malignancy and up to 23% with cirrhosis died during their first admission. The necessity of a willingness to adopt a ‘palliative approach’ to the care of such individuals is obvious. This chapter discusses three features of liver impairment that may be encountered in those for whom palliative care is appropriate.