1.Understand the role of staff from an ethical perspective in situations where parental wishes may not be in the patient's best interest.2.Review current models of ethics to highlight the dilemma that staff may face when dealing with parental requests in the face of their child's advancing illness. By delineating our ethical responsibilities, we will be better prepared to proceed through the decision-making process.3.Understand approaches to shared decision making with parents (and children, when applicable) in the face of advanced disease.4.Review current models of decision making and examine ways in which we may improve our ability to present choices and make recommendations to best serve the interests of both parents and patient.5.Understand the current definitions and use of palliative chemotherapy.6.Review the current literature on palliative chemotherapy, highlighting ways we may introduce the concept to help negotiate care in the setting of advanced illness. We will also emphasize areas where further research is needed. With advances in supportive care and new experimental therapies constantly emerging, transitioning in pediatric oncology from treatment with intent to cure to palliative care has become increasingly complex. Through presentation of a scenario in which parents of a child with a progressive solid tumor requested aggressive chemotherapy despite their child's poor condition, we will examine several major topics in pediatric palliative care. First, Dr. Sarah Tarquini, a psycho-oncologist from Dana-Farber, will discuss our ethical responsibilities. Do we respect parental autonomy regardless of the cost to the child, or do we have an ethical responsibility to advocate for the child's best interest? In addition, we will look at the related issue of therapeutic alliance and models of decision making. We will discuss various ways in which we present options and negotiate care. To what extent do we provide choices, and to what extent recommendations? What if the requested therapy is not the option that we feel is in the patient's best interest? How do we negotiate decision making between parent, child, and staff? Dr. Elisha Waldman, pediatric oncologist and fellow in pediatric palliative care at Harvard, will then discuss chemotherapy and the transition to palliative care. Specifically, we will attempt to define palliative chemotherapy and identify when it may help in negotiating care in the face of advancing cancer—and when it may not. For each of the above topics, we will review the current literature, giving participants an understanding of the current state of research as well as areas where more work is warranted. The discussion will be relevant not just to oncologists, but to anyone caring for children with advanced illness, especially where there is an option of experimental therapies or invasive procedures. We will leave time for discussion at the end for these extremely thought-provoking issues.