Infants with life-terminating conditions (ILTCs) are those whose conditions prevent them from living more than two years. When these infants have difficulty assimilating food and fluids orally, doctors can provide nutrition and hydration through artificial means. While artificial nutrition and hydration (ANH) can provide benefits, it can also result in complications leading to pain and/or distress in addition to that which an ILTC may already be experiencing from one or more underlying conditions. Many medical experts maintain that withholding or withdrawing ANH can help a patient’s body produce its own analgesics. I consider four categories of ILTCs: 1) infants who receive prognoses of two weeks or less; 2) infants who will live longer than two weeks but no more than two years and who are not suffering or in distress; 3) infants who are not dying, but are in distress from the use of ANH; and 4) infants who are not dying, but are in distress from their conditions and/or ANH. I argue that in addition to providing natural analgesics, withholding or withdrawing ANH is a form of comfort care that prevents the occurrence of further complications requiring additional medical treatments and keeps ILTCs content. Under certain circumstances, the withholding or withdrawing of ANH should be obligatory. As it stands, the whole of Catholic teaching on ANH is inconsistent. Operating from the sanctity-of-life ethic, the Church teaches that ANH is an ordinary, therefore obligatory, form of care. But this position contradicts the view that any form of care presenting a grave burden to a patient and/or his family is extraordinary and therefore optional. In addition, by making ANH obligatory, the Catholic Church causes families to undergo heroic suffering (i.e., enduring more than what can be expected or asked of anyone), which the Church says is not required of everyone. I argue that rethinking the Catholic position on ANH will enable the Church to offer practical moral guidance for families to comfort ILTCs, help ILTCs and their families avoid heroic suffering, and provide spiritual care families of ILTCs need, all while still respecting the sanctity of life of every person.

Advance Care Planning has been advocated for over 20 years as a way in which individuals who are no longer able to speak for themselves, may still convey their preferences regarding a wide of array of decisions, including medical care. Advance care planning may not be initiated by individuals for many reasons, and even when initiated, may not be specific enough to help guide decision making. Recent advance care planning models have utilized disease specific information to help guide end of life health care decision-making. Persons diagnosed with mild cognitive impairment face an increased possibility of developing dementia at some point in the future, but may retain decision making capability for a window of time, and thus the opportunity to participate in advance care planning. The advance care planning experiences of individuals with mild cognitive impairment have not been extensively studied. This study explored the advance care planning experiences of persons with mild cognitive impairment and their care partners' understanding and views of advance care planning, and if the diagnosis of mild cognitive impairment affects the advance care planning practices of these two groups. A convenience sample of 10 individuals with mild cognitive impairment and their 10 care partners (n=20) were recruited and interviewed. Using a grounded theory qualitative analysis approach, four themes were identified (1) decreased awareness regarding advance care planning from individuals with mild cognitive impairment versus a heightened awareness for the care partners; 2) the preference for comfort care measures only; 3) preferences for future end of life healthcare decisions largely influenced by previous end of life experiences with family and friends; and 4) lack of discussion of end of life healthcare decisions related to dementia and/or artificial nutrition and hydration by physicians or other healthcare providers. In addition two latent themes emerged including from the care partners, the importance of the mild cognitive impairment support group and lawyers for advance care planning and from both care partners and the mild cognitive impairment participants, trying to maintain autonomy, to `hang on' to self were identified. Study implications include the need for structured advance care planning interventions with individuals diagnosed with mild cognitive impairment to focus on common end of life scenarios, such as whether to use artificial nutrition and hydration, which will require future surrogate decision making.