Abstract
<jats:title>Abstract</jats:title> <jats:p>Whilst decision-making in palliative care is based on the same ethical and legal principles that apply to all children and young people (CYP), assessing the balance of burdens and benefits and engaging the CYP in decision-making can be more complex. In this chapter, the authors address some of the specific ethical quandaries that face those caring for children at the end of life: who holds responsibility for decision-making, resuscitation decisions, withdrawing or withholding artificial nutrition and hydration, and the contentious issues of palliative sedation and the principle of double effect. Healthcare professionals must build relationships with families that are shaped by mutuality and reciprocity. Key to ensuring the effective and compassionate communication required in palliative care is a level of self-awareness and reflective practice on the part of the practitioner, as well as a clear understanding of the ethical and legal issues.</jats:p>