Efforts in advance palliative care planning for the fetus at risk of dying are as meaningful and should be as clinically and socially acceptable as the provision of continued life-extending endeavors. The diagnosis of a fetus at risk of dying because of a lethal anomaly or prematurity is a monumental moment in a family's life. It requires not only extensive team counseling about complex neonatal and obstetric medical management but also acknowledgment, counseling, and support of complex mental health, ethical, spiritual issues. To participate in the care of these families during a tremendously personal time is sad but also rewarding personally and professionally.