Caring for a critically ill or severely injured person is clinically demanding, ethically challenging, and often stressful. When that person is a child, the demands, challenges, and likelihood of stress are compounded. This month’s authors explain the rigorous ethical consideration that must be given to treatment decisions that cannot be made by the patients themselves. Beyond treatment, how should needed research on interventions for critically ill children be carried out ethically, and how can pediatric residents be trained in life-saving procedures so that their skills are honed and ready when they are needed?