Two schools of thought regarding participation in decision making on critically ill infants have developed. One school places the responsibility for decision making in the hands of a forum, and the other school places it in the hands of the parent and physician. These two approaches are examined and contrasted. From the dialectic developed, there emerges a third alternative that potentially encompasses the needs of all involved participants more fully, especially when participants find themselves confronted with difficult decisions and still unresolved conflict. This third approach is the matrix paradigm.