ABSTRACT
All these questions come up almost daily in neonatal practice26 and are often dealt with on an ad hoc basis by relatively junior resident medical staff who may never have had the opportunity to think out all the possible implications of the actions they have to take. Not only do these decisions have to be made quickly but they need to be made with at least the tacit assent of all involved: the doctor who gives orders, the nurses who carry them out, the parents who are most deeply concerned and will have to bear most of the consequences of whatever decision is made, the hospital authorities who are ultimately answerable for the way resources are deployed, the ancillary staff who may be present as helpers, spectators or indeed critics, and the local community which the hospital serves.
