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Background & Aims The ethical challenges of pediatric nurses in the work environment is inevitable. One of these challenges for nurses is related to euthanasia, which is affected by extensive legal, religious, and cultural issues. This study aims to determine the relationship between ethical reasoning and attitudes towards euthanasia in nurses working in children’s hospitals. Materials & Methods This descriptive-analytical study was conducted on 194 pediatric nurses working in two children’s hospitals affiliated to Tehran University of Medical Sciences. Data were collected electronically and in person using three questionnaires, including a demographic form, the nursing dilemma test (NDT), and the euthanasia attitude survey (EAS). The collected data were analyzed in SPSS software, version 26. Results The mean score of ethical reasoning was 42.92±10.33, and the mean score of EAS was 2.65±0.12. The ethical reasoning score had no significant correlation with age, work experience, sex, marital status, education level, and history of participation in nursing ethics courses, except for the department, which was significantly related to ethical reasoning. The EAS score had no significant correlation with any of the demographic variables, except for the department. The Pearson correlation test results indicated a significant negative correlation between ethical reasoning and attitudes toward euthanasia (r=-0.60, P<0.001). Conclusion The ethical reasoning of pediatric nurses in the study hospitals is at a moderate level, and they have a negative attitude toward euthanasia. The nurses with higher ethical reasoning have a more negative attitude toward euthanasia. Nurses from special care units and emergency departments have lower ethical reasoning but a more positive attitude toward euthanasia. Participation in nursing ethics workshops has no significant relationship with ethical reasoning scores and attitudes toward euthanasia. Based on the findings of this study, it is recommended that comprehensive educational programs should be held to strengthen the ethical reasoning of pediatric nurses and enhance their perception of euthanasia. [ABSTRACT FROM AUTHOR]