Abstract
Periviable births, occurring between 20 and 25 weeks of gestation, present significant challenges due to varying survival rates and potential morbidities for survivors. Medical decision-making in this context raises ethical and legal questions, including considerations of sanctity of life versus quality of life and challenges in the clinician-parent relationship. This article outlines the complex ethical and legal landscape surrounding parental medical decision-making for periviable infants in the United States, discussing the evolution of federal and state laws. Existing laws highlight a vitalist approach that prioritizes life preservation despite potential harm and overlook non-heteronormative and non-traditional family structures, complicating decision-making. The impact of post-Dobbs state abortion bans on parental and clinician autonomy have exacerbated these challenges. We advocate for legislative support for inclusive definitions of legal parenthood to facilitate evidence-based decision-making centered on patients and families. Also needed are legal frameworks that accommodate the intricacies of periviable birth decisions while respecting patient autonomy and medical expertise, especially amidst the evolving legislative environment.