This text is part of the chapter 7 of a special issue supplement called “Death and Dying in PICU” having Christopher S. Parshuram and Karen Dryden-Palmer as the guest editors. I present my personal perception regarding the modes of death and the dying process in Brazilian PICU over the last 30 years. A big change in this regard was observed in our country from the 1980s to nowadays. The PICU mortality rate decreased significantly from over 20% to below 5% as well as the modes of death being observed that the life support limitation is far the most frequent death process in the PICU. Palliative care, in the last 10 years, increased its coverage in our country and being frequently offered as a complementary care to terminal ill patients in the PICU.