Over the past year, the Surfactant, Positive Pressure, and Oxygenation Randomized Trial (SUPPORT) has generated yet another rich debate relating to the study of treatments that fall within the standard of care. This was triggered by the investigational intervention – the compliance-oversight determination letter (2) – by the Office for Human Research Protections of the US Department of Human and Health Services. A large number of bioethicists, researchers, members of ethics review boards, neonatologists and parents of those receiving care have contributed to this discourse.