Pediatric palliative care is the medical subspecialty that provides total care for the body, mind, and spirit of a child with an illness and support for his or her family. The care can begin when a child is diagnosed and continue throughout the illness, whether the outcome is better health or death. The stark ethical concerns in pediatric palliative care range from respecting the developing moral autonomy of the child to effects of the illness on siblings and heartrending decisions to discontinue life-sustaining treatment. July contributors examine these and other matters with penetrating clarity and compassion.