Decision making in pediatric emergency and critical care settings is strikingly different than it is in adult medicine.

When ventilator support is being withdrawn from a dying child, responsive titration of sedative medications by the ICU team can relieve suffering without anesthetizing the child completely or hastening death.

Courts considering teenagers' refusal of life-saving treatments often consider their maturity, the beliefs underlying the refusal, their parents' wishes, and the chances that treatment would cure them.

Research in the PED and PICU is essential to medical understanding of the efficacy of emergency interventions. Researchers must minimize the additional stress that consent and participation in research entail for pediatric patients and their families.

However good the intentions, calling a slow code to protect an infant from futile, aggressive treatment raises significant ethical questions about deceit, paternalism, patient-doctor relationships, and teaching good communication skills.

Caring for pediatric disaster victims requires special equipment, resources, and training.

When considering off-label therapies in neonatal and pediatric patients, review available information about potential risks and benefits, carefully balance parental autonomy and the child's best interest, seek informed consent, and consider whether there is an opportunity to systematically evaluate the therapy.

When a severely ill child comes into the emergency room, assent for emergency care is no more required than is parental permission. Conveying the needed care is the top priority.

Given the limited opportunities for experience in most pediatrics training programs, computer-based learning and simulation should be used to teach procedures before real patient encounters.

The AMA Code of Medical Ethics' opinions on confidential services for children and adolescents.