Background Neonatologists encounter many ethical dilemmas including limits of viability, conforming to parental wishes whilst also considering best interests of the infant, ethics of withdrawing care and provision of palliative care. These issues are further complicated if patients are infants of foreign nationals who are not ‘entitled’ to free NHS care. We describe 2 cases and the ethical dilemmas they posed.

Objectives To explore the practical application of ethical principles in resolving these clinical dilemmas.

Methodology Retrospective analysis of case records and case discussions.

Case 23 and 26 week gestation infants born to African mothers visiting the UK as tourists. The dilemmas were whether or not to resuscitate these infants at the margins of viability and whether these UK defined margins of justifiable survival can be extrapolated to other countries. Other dilemmas included; when to discuss payment of medical bills with the parents; in the presence of finite resources do we owe a greater duty of care to these infants or those displaced by their requirement for intensive care; to what extent should these parents influence decision making and what is ethically in the best interests of the child; impact on decision making of known lack of resources and infrastructure in the home countries for long term follow up after discharge.

Discussion These cases highlight the difficulties of financial considerations superimposed on pre-existing ethical dilemmas within neonatology. The anticipation of ethical dilemmas and early and frank communication with parents can aid in acting in the best interests of the child.