This discussion will consider how different courts deal with difficult cases, and how courts seek to maintain the legitimacy of their judicial authority. How do courts search for legitimacy? From what sources do they draw their legitimacy? As a central example I will use the problem often referred to as the “wrongful life” cases: can a medical care provider be held liable for negligent malpractice that results in the creation or preservation of a life that is not considered worth living? This question touches upon the autonomy of the plaintiff. By comparing three judicial decisions in “wrongful life” cases from courts from the United States, France and the Netherlands I hope to illustrate different possible sources of judicial legitimacy.