In 1988, 33 delegates from 10 countries met to produce a set of guidelines for discussion concerning decisions to forego medical treatment. A study edition of the guideline was distributed to 152 discussion groups that met in 15 countries for study and comment. Their responses were summarized for 24 delegates who met in Appleton, Wisconsin, and produced the document The Appleton International Conference: Developing Guidelines for Decisions to Forego Life-Prolonging Medical Treatment.(245) Part III dealt with decisions involving neonates. The guidelines were as follows:

1. Regard for the value of life does not imply a duty always to employ life-prolonging treatment for patients in this category. In setting reasonable limits for such treatment ‘third person’ judgments about quality of life are inevitable. Responsible third-person quality-of-life judgments consider, in so far as possible, how the options must appear from the perspective of one in the patient's condition and determine what would most reasonably be thought to count as quality for most such patients.

The delegates warned that the quality of life judgment should not be based on concepts of minimal social worth, which was not morally justifiable. Some argued that to consider how options appear to an infant, who has never been competent, is misguided. They considered that this was an “inappropriate projection of others' interests onto the infant.” Even so, it was felt that if a quality of life judgment was to be made it was the responsibility of those making the judgment to ascertain “… as far as possible, what most such patients would count as quality.”