Decisions about optimal treatment for critically ill children are qualitati
vely different from those related to adults. Technological advances over th
e past several decades have resulted in myriad treatment options that leave
many children chronically, critically ill. These children are often techno
logy dependent. With new technologies and new patient populations comes the
responsibility to understand how, when, and why these technologies are app
lied and when technology should not be used or should be withdrawn. Much ha
s been written about ethical decision making in the care of chronically, cr
itically ill adults and newborns. In this article, relevant factors about t
he care of children older than neonates are described: standards, decision
makers, age of the child, and pain management. A case study is used as a me
chanism to explore these issues. Dimensions of futility, discontinuing aggr
essive treatment, and a consideration of benefits and burdens are integrate
d throughout the discussion to inform nurse practitioner practice. Copyrigh
t (C) 2000 by W.B. Saunders Company.