As health care professionals face difficult decisions about late-term abortion and neonatal care they confront limits that ethics and the law imposes. Perinatal decision making is never easy but is considerably more difficult when legal standards and ethical norms conflict as they do in nations that either fail to reasonably restrict or in contrast, excessively curtail late-term abortion or neonaticide. Unrestricted late-term abortion may infringe upon those moral interests of the fetus that warrant state protection. Excessively strict regulations that virtually ban late-term abortion may unjustifiably threaten the health and welfare of parents, families and indeed, the fetus itself. Management strategies for impaired neonates are beset by similar difficulties. Parents allowed to let a denying parents the right, to allow a severely impaired newborn to die, condemns it and its family to unnecessary pain and suffering. Ethical policy hinges on two underlying normative issues: the question of fetal/newborn status and the morality of killing and letting die. While each issue has been the subject of extensive debate, there are firm ethical norms that should serve as the basis for coherent and consistent perinatal policy. The need for practical guidelines and ethically consistent public policy may demand a degree of public activism from perinatologists that is not generally recognized. Some broad guidelines are suggested, Practitioners in each community must engage professionals, patients and their families in ongoing public discussions to formulate the proper and acceptable guidelines for late-term abortion and neonaticide.