The education of school students with profound intellectual and multiple disabilities presents diverse challenges to practitioners, families and policymakers. These challenges are philosophically and ethically complex, and impact curriculum, assessment and pedagogy. Given the international ascendancy of both the UNESCO Policy Guidelines on inclusion in education and the principles of inclusion for people with disabilities with respect to human services policy and practice, the authors build on their previous work to advocate for renewed debate about the nature of school education for these students, and put forward four pathways to inform this debate.