In Reply.—Dr Kopelman, in the March 2005 issue of Pediatrics,1 reviews the history of the “Baby Doe” rules and the American Academy of Pediatrics' (AAP) responses to them, especially the 1996 Committee on Bioethics (COB) statement “Ethics and the Care of Critically Ill Infants and Children.”2 Kopelman calls for the AAP to repudiate the federal law and its implementation. Dr Clark agrees with her in a letter in the August 2005 issue of Pediatrics,3 and Dr Hurst, in this issue, disagrees. As the chairperson of the COB responsible for drafting the 1996 AAP statement, I have been asked to respond.Speaking for myself only, I support the substance of the arguments by Kopelman and Clark. The Baby Doe rules should never have come into existence and have not advanced the cause of clear or good decision-making for critically ill infants or children. As I understand it, AAP leaders in 1984 felt that they had to support the “compromise” language of the Child Abuse Amendments out of fear of even more intrusive and controlling legislation. When the COB crafted the 1996 statement, our wording was perhaps more wishful than anything else. The AAP leadership for many reasons did not want to renounce its earlier stand. When asked to perform a routine review of previously published policies (the AAP's 1983 statement “Treatment of Critically Ill Newborns,”4 a 1984 AAP-endorsed statement entitled “Principles of Treatment of Disabled Infants,”5 and the 1984 “Guidelines for Infant Bioethics Committees”6), the COB looked for ways to support individualized decision-making rather than government mandates to treat come-what-may, including pointing out real ambiguities in the language of the law. The COB chose not to focus on the Reagan-era politics that produced the legislation and regulations or the AAP responses.The courts have never taken on the Baby Doe law and rules directly, and we do not know how judges would interpret the unclear language of the Child Abuse Amendments. Some might see the wiggle room to which the COB, in hope, referred. Others might focus on congressional intent, especially as interpreted by the subsequent regulations, in accord with Kopelman. In any case, I agree with Kopelman and Clark that, after all this time, we (including the AAP) should clearly say that the federal intrusion on factually and morally disputed decisions in the NICU was and remains a bad idea and should go away. Having indicated that, however, I doubt that insisting on the reliance on the “best-interests” standard gets us very far. Best interests, similar to art or pornography, tends to mean whatever the beholder believes it to mean. The term has no independent substance, and we should not fool ourselves into thinking that it alone improves decision-making. Hurst's protest that denouncing the Baby Doe law and rules would amount to “shooting one's self in the foot” does not get around the lack of substance in the best-interests mantra. The AAP and those of us interested in bioethics should do much more to flesh out substantive guidelines for decisions.