Professor Douglas S. Diekema (Director of Education for the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Research Institute) opens the Conference by considering the ethical underpinning of the conference theme, 'Deciding with Children'. Deciding with Children is more than a vague abstraction or aspirational goal of children's healthcare workers. Prof Diekema demonstrates that Deciding with Children matters to the well-being of children and is a vital part of healthcare delivery. He builds on this foundation, using his clinical experience, to consider how best to authentically involve children in healthcare decisions. This Keynote session is named in honour of the recent Clinical Director of the Children's Bioethics Centre, Associate Professor Jill Sewell.