In Reply I thank Frader et al for their thoughtful response to my Viewpoint. They are compassionate physicians who care for extraordinarily vulnerable children and families and are concerned that children receiving palliative care will suffer unnecessarily in response to the call for more cautious use of opioids that is increasingly being advocated by many physicians. They worry that gains that have been made in pain management during the past 30 years will be swept away by the tidal wave of fear of addiction and diversion that they perceive is occurring.