'We didn't do anything wrong, we tried our best, but they just died...; we tried, we really tried'

This article argues that child deaths in the Paediatric Intensive Care Unit (PICU) generate profound moral struggle amongst caregivers. In it I deconstruct how caregivers manage the messy and at times problematic circumstances that clinical necessity requires from them in order to save children's lives. One result of this is that on many occasions they care for them at their time of death. When deaths are well managed compassion is engendered into the child's dying and the death becomes restorative for the family and unit. In this, consultants – who are intensive-care specialists – play a critical role as they take responsibility for the clinical management of child deaths. In doing so, they inform a team-based deliberation process to consider the child's clinical assessment in the context of other ethical and moral issues. In addition, consultants must take part in the social negotiation of these events with family and caregivers. Nurses in contrast are more intimately involved in child deaths and are shown to be more affected by the emotional, psychological and social consequences of deaths. The discussion further proposes that the nature of moral struggle is confounded by a complex of related factors that arise in a South African landscape, critical among which are the past inequities brought by apartheid and this makes the deaths of children particularly sensitive. These inequities are now inherent in a geographical context influencing the demographic and epidemiological profile of disease that children suffer from and thereby, their chances of survival on admission to the hospital and the deaths that occur.