The care of extremely premature infants involves a number of complex clinical and ethical issues. The ethical and scientific quality of decisions made in the care of these infants has profound long-term consequences for these infants and their families. In circumstances when it is unclear whether intensive care should be initiated or continued, evidence-based ethics provides an approach to facilitate treatment decisions that over time will be progressively better informed, better justified, and more broadly acceptable to parents, caregivers, and the general public.