The importance of medical ethics in the care of children with medical complexity (CMC) is evidenced across the healthcare continuum, from individual children and their families to provider teams, and from regional to national systems of care. Understanding our recent US history of disability rights and experiences of ableism heightens our awareness of implicit biases and influences our approaches to care. CMC are best served by comprehensive clinical teams that adapt to the changing needs over time, with continuous attention to the unique values and goals of each child and family. Across the lifespan, as CMC and their families encounter critical decision points, shared decision-making processes in goal-directed approaches can support all stakeholders in balancing potential over- and under-utilization of medical care. Medical decisions and healthcare transitions can be optimized when grounded on the pillars of medical ethics: nonmaleficence, beneficence, autonomy, and justice.