In the high-technology and often high-tension milieu of the neonatal intensive care unit (NICU), nurses and other healthcare professionals inevitably encounter ethical issues. However, ethical issues involving neonates are not limited to the NICU. Neonatal nurses are providing comprehensive care in an increasingly complex environment for a very diverse population. These challenges will continue to bring ethical issues to the forefront of neonatal care and will require thoughtful reflection. Ethical issues are often intertwined with legal considerations, further adding to their complexity. Nurses may experience moral distress related to the complexities of care and associated ethical dilemmas. Neonatal nurses and advanced practice neonatal nurses are well positioned for leadership roles in managing ethical and legal issues in the neonatal care settings. This chapter provides an overview of ethical and legal issues that can arise across the spectrum of neonatal care, as well as approaches to recognizing and managing these issues.