This study is concerned with understanding decision-making in relation to out-of-authority educational placements for pupils with an Autistic Spectrum Condition (ASC) in one Local Authority (LA). The aims of this research were twofold. The first was to explore what factors have the greatest impact on the decision to educate pupils with an ASC outside the local authority. The second was to explore the perceptions of key informants about the process for deciding those placements. The study involved examining 24 pupil cases where out-of-authority ASC placements had been agreed and interviews with case-informants contributing to those placement decisions in order to analyse their beliefs and understandings about the processes of decision-making. The literature review highlights the limited research with regard to decision-making about pupils with Special Educational Needs (SEN) and draws examples from medical decision-making frameworks. Data analysis showed that two factors, complexity and range of pupil need and lack of LA provision to match the needs identified had the greatest influence on the decision to educate pupils outside the local authority. The response of the LA's own schools, professionals and parents to those presenting needs as well as the consequent impact on the child/young person and others were recognised secondary factors. Case-informants offered a strong impression that for the majority of these pupils successful inclusion in their own LA would require increased and more integrated services in order to meet their identified needs. Data from the qualitative interviews provides a sense of the range of informants' experiences relating to decision-making processes and the factors determining those perceptions. These related to whether the processes had been experienced as planned, were evidenced-based, child-focused and involved effective working with parents and other agencies. The findings, in part, reflect government concerns about the current statutory SEN framework and the case for change as made in the recent Green Paper (DfE, 2011). At a local level informants identified the need for a more explicit model of decision-making, ethically grounded with an emphasis for decision-making to be based on the holistic needs of the child and viewed that this would be better facilitated by having improved joint-working between services and stronger partnership engagement between the LA and parents/carers. Clinical professional-patient shared decision-making is discussed as a potential model which might be usefully applied to better understand and develop current SEN decision making.