To discuss, in the case of the baby Charlie Gard, aspects to be considered in medical decision making in pediatrics, especially in patients with incurable and terminal diseases. Bioethical principles and Palliative Care were considered, as well as legal issues related to parental authority and therapeutic obstinacy, from the perspective of the Brazilian legal system. Decisions related to end-of-life care in pediatrics should be a process of sharing responsibilities between the health team and parents, with the participation of the child whenever possible, seeking the principle of the best interest. Judicialization of medical issues must be avoided, as it is associated with attrition and suffering for all parties involved. End-of-life decision-making in pediatrics should be based on the search for the right to live with dignity, but, above all, to maintain it until the end of life.
Mitochondrial diseases; Palliative care; Bioethics; Decision making; Medical futility