Background: Palliative medicine in Canada continues to be limited by system-wide resource and funding constraints precluding its early integration into standard treatments. Specialist palliative care (SPC) services continue to be underutilized among surgical patients, even in regions that exhibit widespread cultural acceptance of SPC. Moral distress in health care is linked with systemic and institutional resource limitations resulting in clinician burnout. The objective of this study was to explore the perceptions about palliative care among BC general surgeons. Methods: This report represents part of a larger exploratory study designed to gain an understanding of palliative care delivery from the experiences of BC general surgeons. Participants were recruited through the BC Surgical Society (BCSS) to complete a self-administered, computer-based survey and invited to participate in an optional semistructured interview. Interviews were recorded, deidentified and transcribed. Analyses were conducted via interpretive description in thematic analysis. Codes and emergent themes were identified through iterative discussions and comparisons. Results: Forty-one general surgeons completed surveys, and 11 consented to semistructured interviews conducted between November 2020 and April 2021. Three overarching perspectives were identified central to a theme of moral distress: 1) systemic resource limitations delay the delivery of primary palliative care in surgery, 2) caring for patients with life-limiting disease poses emotional and professional exhaustion, and 3) surgeons perceived a poor delineation of responsibilities in integrating primary and SPC into surgical practice. These themes correlated with feelings of distress related to personal uncertainty, discomfort, and of poor access to SPC for surgical patients throughout the province. Conclusion: General surgeons acknowledged the need and emerging role of SPC in surgical practice. These perceptions remain focused toward end-of-life and definitively noncurative trajectories as opposed to an integrative approach where outcomes are uncertain. Moral distress is a negative perpetuating phenomenon that forestalls the earlier integration of palliative care in surgical practice.