A well-documented communication gap exists between health care providers and families in crisis. The origin of the communication gap is not known although influences of the breakdowns are evident in literature, relationships with the public, and lawsuits. The purpose of this qualitative, collective case study was to explore the dialogic encounters among pediatric health care providers in an acute care setting in order to better understand the way decision-making is achieved. A collective case study using Conversation Analysis was used for this research because the methodology supports the purpose of the study. Randomized patient scenarios were used to form the collective case study through which the dialogue of ten deidentified health care providers was analyzed for the emergence of themes. Six themes emerged from the data. Health care providers may not be cognizant of the influences of silent dialogic components on decision-making practices. Ethical health care practitioners should cultivate awareness of intent as a component of ethical dialogue precipatory to decision-making.