In Reply.—I appreciate the comments of Drs Carter and Sparks on my article concerning the Children's Hospital National Medical Center Ethics Forum. However, they misunderstood several elements of that report. Nowhere in the article did I imply that pediatricians have more competence in making moral decisions than patients, families, or other members of the lay community. But pediatricians are not expected to have less competence. As Drs Carter and Sparks state, pediatricians have "special knowledge and responsibilities in dealing with children." One of those fiduciary responsibilities is to reduce or prevent the patient's pain and suffering when treatment is futile. Along with other health care professionals, therefore, the pediatrician is expected to act as a moral agent for the fatally ill child.
Concern is also expressed by the commentators that our proposed policy's goal is only to prolong life. This is not its sole intent. Nonmaleficence and beneficence are