This article provides a discussion of ethical and policy issues facing pediatricians and hospitals today concerning treatment of undocumented children, especially regarding lifesaving measures like chemotherapy or transplants. It uses a case study of a 10-year-old Mexican boy to duscuss the following questions: Should hospitals with special pediatric expertise have formal policies on providing expensive lifesaving care to uninsured children who are undocumented? To what extent can hospitals absorb expenditures associated with providing this care without compromising new and/or existing clinical programs? Other questions deal with whether hospitals providing this expensive care will attract other undocumented children or those directly from Latin America; whether denying acute and chronic care result in higher expenditures related to preventable hospitalizations and have unintended public health consequences; whether arrangements can be made to return these children to their countries of origin to receive expensive treatment be made. There is also a discussion of policy initiatives undertaken.