Sometimes a patient’s life can be saved but the price that must be paid, in terms of the burdens of treatment and the painful sequelae, can be considered too high. In this month’s “Ethics Rounds,” we present such a case from a Dutch ICU. We ask 2 experts, 1 from the United States and 1 from the Netherlands, to comment on the case. Dr Peter J. Smith is a developmental pediatrician at the University of Chicago. Professor A.J. van Vught is the director of the pediatric ICU at the Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, Netherlands. Finally, 1 of the doctors involved in the case, Wendela G. Leeuwenburgh-Pronk, discusses the outcome. Sophia, an 11-month-old baby, developed high fever, malaise, and a rash. Her parents took her to a nearby hospital. In the emergency department, the pediatrician diagnosed septic shock with purpura fulminans. Antibiotics were started, and she was transported to a PICU 1 hour away. She had been a full-term baby with no health problems. Her immunizations were up to date, including vaccination against Neisseria meningitidis type C. On PICU admission, she was intubated and started on ventilatory support. She developed a severe refractory septic shock with disseminated intravascular coagulation and rhabdomyolysis. She required intensive inotropic and vasopressor support, fluid resuscitation, and supplementation of blood products. She recovered from the septic shock. However, all 4 extremities and the buttocks showed severe necrotic lesions. Both hands and feet were irreversibly necrotic, most likely necessitating amputation. There was necrosis of the proximal muscles. Her long-term prognosis for motor function was uncertain. After a series of multidisciplinary meetings that included intensivists, rehabilitation specialists, and plastic surgeons, the doctors agreed that the best case scenario was to amputate both hands and feet. The worst case scenario would require amputation of all 4 extremities … Address correspondence to Wendela G. Leeuwenburgh-Pronk, MD, IJsselland Hospital, Postbox 690, 2900 AR Capelle aan den IJssel, Netherlands. E-mail: wpronk{at}hotmail.com