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Over the last twenty years, the technologies of medicine have had a greater impact on the survival rates of neonates at ever earlier gestational ages. However, while survival rates have improved morbidity among very premature infants remains high. The use of such technologies leave us with specific ethical issues to deal with: who has the autonomy to make such decisions for an infant that cannot speak for itself? Is life to be valued at any cost? Who decides what counts as severe morbidity? Drawing on previous research, this paper will consider the decision-making that goes on in the neonatal intensive care unit and consider what possible disjunctures there may be between frameworks for practice and what happens in reality and what social factors might influence the decisions made.