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.

It is now after leaving the hospital breast-fed infants and 4.5% only 34% of infants are breastfed for longer than six months. If the mother is unable or unwilling to breastfeed her child, comes the work of children's nurses, which should comprehensively educate mothers on the artificial feeding. This work focuses on the problem of feeding the newborn. Its task is to map the role of pediatric nurses in the education of artificial infant feeding, as well as identify the reasons for mothers to stop lactation and the transfer of their children - infants to artificial feeding. We tried to find out what are the errors in the application of artificial infant feeding, which is committed by mothers, and whether it is possible to eliminate these errors led education process of children's nurses. The research part of our work was the method of quantitative-qualitative research. For qualitative research, data collection technique was used semistructured interview. The interview was anonymous. Quantitative research was conducted through interviews. The questionnaire was anonymous. It contained 23 questions. Research files of qualitative research, mothers are mothers who use feeding their newborn infants artificial nutrition products. This set of nine respondents were selected in the Region. The research sample consisted of quantitative research for pediatric nurses, working in the department of physiological neonatal hospital South Bohemia. The results of our work we want to move the broader public, mothers who have decided, at its discretion, that are unwilling or unable to breast-feed. We created educational material to make the children's nurses working at the department of physiological and pathological newborn, as well as nurses in primary care.

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.

Bakgrund: Vid palliativ vård i hemmet förändras tillvaron såväl för den sjuke som för de närstående. Den sjuke har ofta svårt att äta vanlig mat och kan behöva tillförsel av konstgjord näring. Närstående kan uppleva ett stort ansvar för den sjukes näringsintag när han eller hon vårdas hemma. Adekvat näringsintag är av betydelse för det fysiska välbefinnandet. Men vad vi äter påverkar också livskvalitet i social, kulturell och psykologisk bemärkelse. Tillgänglig forskning om hur det kan vara att leva med någon som är beroende av konstgjord näring i relation till svår sjukdom har i stor utsträckning ett biomedicinskt perspektiv och fokus på praktiskt handhavande och tekniska problem relaterade till näringsbehandlingen. Syfte: Att få ökad kunskap om närståendes erfarenheter av att ha delat vardagen med en partner som fått konstgjord näring i livets slutskede. Metod: Kvalitativ induktiv ansats med datainsamling genom öppna enskilda intervjuer. Datainsamling/databearbetning genomfördes med tolkande beskrivning. Resultat: I resultatet har tre övergripande teman och dess inneboende variationer identifierats; situationer kring mat och näring skapar delaktighet och utmanar; strävan efter vardaglighet genom måltider i en förändrad tillvaro; näring skapar förhandlingsutrymme med döden. Den konstgjorda näringen skapade en trygghet för de närstående, både som en försäkran om en fortsatt existens och genom den kontinuerliga kontakt med hemsjukvårdsteamet som näringsbehandlingen medförde. Personerna i studien beskrev positiva aspekter av att vara delaktiga i vården av den sjuke, men också känslor av maktlöshet och skuld inför att inte lyckas överskrida den sjukes svårigheter att äta och dricka. I den förändrade tillvaron kunde de närstående personerna finna det goda men de upplevde också ett främmandeskap inför sin sjuka partner. I situationen kunde näringsintaget utgöra ett existentiellt hot eller hopp. Slutsats och diskussion: Resultatet illustrerar hur komplex situationen att leva med en svårt sjuk partner som i livets slutskede har svårt att äta och behöver tillskott av konstgjord näring, kan upplevas. Personernas erfarenheter var varierande och det kan antas vara av betydelse att vårdpersonal har stor öppenhet för hur den förändrade vardagen upplevs för varje enskild närstående. En öppen och ömsesidig dialog kring ätsvårigheter och konstgjord näring kan vara av stor betydelse för de närståendes förmåga att hantera vardagen med den sjuke.