This chapter articulates a pragmatic approach to ethical decision making in intensive care. Dealing with critically sick patients at the cutting edge of medical technology, there are life and death decisions to be considered every day. The four principles of medical ethics, the Ethics of Care, and Narrative Ethics are discussed, along with the multiple obligations inherent in caring for both patients and their families and caregivers. Principles of procedural justice are explored, and a short vignette is used to illustrate decision-making processes in the intensive care environment.