This article examines the difficulties of defining perinatal asphyxia. Once the central clinical concern is identified, the ethical questions become clearer. A variety of procedural and ethical issues also need to be considered; especially those related to how physicians introduce and dialogue with parents about difficult life and death decisions. Depending on how well this is accomplished, sound medical practice, parental autonomy and the patient's best interest issues can all be effectively addressed with a minimum of conflict.