Johan Bester (Medicine) published an article on the use of the harm principle as the ethical decision-making standard in the medical care of children. This article, published in the American Journal of Bioethics, generated substantial debate through a series of commentaries appearing in the same issue, with Bester also being given the opportunity to publish a response to these commentaries. This lively discussion highlighted some new and ongoing issues in the field of pediatric ethics, and sets the stage for ongoing work on how we make medical decisions for children.