Decisions regarding life-sustaining treatment for extremely preterm infants are frequent in neonatal intensive care units. These decisions are determined by prognostic judgment, the perceptions and ethical beliefs of health professionals and parents, and the prevailing law of the land. However, specific prognoses may be difficult and perceptions of later outcome and ethical beliefs are variable. There is disagreement concerning the circumstances in which life-sustaining treatment should be withdrawn or withheld and who should decide this. In different ways, legal practices have developed around the world that attempt to address this problem. Laws have arisen – cases, statutes, and legal code that, to a varying degree, indicate the authority and actions of physicians, parents, and the courts. Legal systems differ between countries and they may be single systems or federations where provinces or states can regulate medicine. Countries such as Britain, Canada, and Australia have common law systems where the law is based on judicial precedent and legislation. Holland, Poland, Germany, France, and Japan have civil and criminal codes, although courts of appeal can make authoritative rulings.(250)

The relationship between ethics and law has been discussed and argued since classical times and will continue to be argued. However, those that frame and adjudicate the law, at a minimum, are required to set clear acceptable operational boundaries. Laws are not determined, necessarily, by ethical rules.