By Mary DeTurris Poust
It's hard to imagine yourself in a hospital bed, unable to make decisions about your own health care, spiritual care or how your life might end.
If the tragic case of Terri Schiavo did anything, it was to make people more conscious of their ability to have a say in their end-of-life treatment, even if they are incapacitated.
Unfortunately, what has happened since Schiavo died, after being denied food and water, is that people are racing to fill out advance medical directives or health care proxies without fully understanding the ramifications of the documents that may one day decide their fate.
The two main legal instruments that are used when a patient is incapacitated are either an advance medical directive, also known as a living will, or a health care proxy, also known as a durable power of attorney for health care. The former is considered more inflexible than the latter because it requires individuals to try to predict their own futures, deciding in advance what medical treatments they do or do not want without knowing specific circumstances.
A health care proxy, on the other hand, is more flexible in that it allows an individual to appoint someone he or she loves and trusts to make decisions in cases of incapacitation.
"You try to imagine a wide range of scenarios that might characterize your future decline. That's not something that most of us are able to do. Our best guess is not likely to match up with the situation that we find ourselves in," said Father Tadeusz Pacholczyk, director of education for the National Catholic Bioethics Center in Philadelphia, of the advance directive. "People are tempted to make overly broad strokes when they make stipulations in a living will."
For example, Father Pacholczyk said that people might state that they "don't want any tubes." But tubes may be a "bridge to healing," he said, adding that people using an advance medical directive should specify that they don't want anything done that would be in disagreement or tension with the teachings of the Catholic Church.
"If there had been a line like that in some written document, Terri Schiavo would not have been dispatched as she was," Father Pacholczyk said.
The National Catholic Bioethics Center has published "A Catholic Guide to End-of-Life Decisions," which includes a health care proxy form as well as an advance medical directive form. However, the guide itself recommends that individuals use a durable power of attorney in lieu of an advance medical directive.
"A health care proxy is the much better approach. You have an individual who you have chosen who is aware of your wishes and with whom you presumably had some discussion. They can stand there and make decisions that address your health care situation. It's not hypothetical anymore," Father Pacholczyk explained.
He said there is a lack of basic education about what the Catholic Church allows with regard to end-of-life treatment and that many people wrongly assume that the Church wants people kept alive at all costs and under any circumstances.
"You are not obligated to use disproportionate means to extend the dying process," Father Pacholczyk said. "Ordinary means are required. This flows from your standard obligation to take care of you own health. Our lives are a gift from God and we have a responsibility to be good stewards of that life."
Father Pacholczyk recommends that Catholics seeking to write an advance medical directive contact the NCBC or their state Catholic conference for guidelines and forms.
Kathleen Gallagher, director of Pro-Life Activities for the New York State Catholic Conference, said that after Terri Schiavo's death there was a noticeable increase in requests for information on living wills and health care proxies.
The New York conference also recommends a health care proxy over a living will and has a health care proxy form available through its website.
"Pragmatically, living wills are inflexible, and they're vague because it's impossible to foresee what the exact medical condition would be in the future as well as what the state of medical technology would be in the future," said Gallagher. "Many living wills are actually 'refuse treatment' forms and thereby they kind of present a presumption of death."
Gallagher explained that New York's bishops have said that the health care proxy is a "morally appropriate tool." The key, she added, is to designate someone who knows your moral and religious beliefs.
The fundamental conflict for Catholics, Gallagher said, is that Church teaching is so clear about the intrinsic value of every human being, no matter how grave the disability, and yet we live in a world where we are led to believe that we should be able to control everything about our own bodies at every moment.
"In the end it's not my life, and not my death. I belong to God. That is a struggle for people," she said.
"The bottom line for Catholics is that they can reasonably say to their health care agent or their proxy, 'I intend that my life not be unreasonably prolonged when my death is imminent or treatment is burdensome, but I don't intend any direct taking of my life.' Church teaching is a wise teaching. It's not just good for Catholics; it's good for everyone."
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