While the first few days of an infant's life usually involve incorporation into a joyous family, this period can also be fraught with conditions that affect and potentially threaten survival. This article explores the ethical components of neonatal conditions such as disorders of sex development and metabolic disorders. Ethical issues surrounding futility, requests for unwarranted care, palliative care, and neonatal hospice are also discussed. Helping parents through the grief process and ensuring that they are provided opportunities to participate in important decisions for their neonate are key components of the nursing role. Implications for clinical practice are provided in the form of a case study and practical suggestions for assisting parents through these difficult situations.