&NA;While the issue of decisions regarding life‐sustaining therapy for critically ill or impaired newborns and young infants remains controversial, there has been an evolution in law, ethics, and policy. This article reviews the history of the topic, the patient population that is the focus of the discussion, the critical issues in defining the questions at hand, the primary role of the family, and the role of the multidisciplinary team members who care for the infant in the neonatal intensive care unit and after discharge. It also reviews established guidelines and other suggested approaches to decision making.