Editor’s note: In the month of November, as we reach the end of the liturgical year, the Church invites us to pray for the dead and to remember our own mortality. It is also important that every priest, regardless of his age or health, take time to plan a will and to have all of the necessary protocols for health care decisions and advanced directives in place. Here, we offer some practical advice.
ADVANCE DIRECTIVE FOR HEALTH CARE
Since the early 1990s, the law of the land has allowed you to express your preferences regarding health care treatment in advance of the time when this may be necessary. The way health care is delivered today has made it even more important that we express in writing, on a form called an advance directive for health care, our preferences for medical treatment.
Long-standing Catholic moral tradition provides excellent guidelines for decision-making for ourselves and for surrogates who speak for us.
We are not morally obligated to undergo medical treatment that is more burdensome than beneficial.
Withholding and withdrawing medical treatment are morally (and legally) equivalent. In either case, we weigh the relative burden and benefit of the treatment in making a decision. For example, concerning a ventilator: the decision to forego such treatment involves the same consideration as a decision to withdraw the treatment. To withhold or to withdraw medical treatment that is no longer providing sufficient benefit is not suicide or assisted suicide.
Treatment may be given, even if some evil may result, as long as that evil is an unintended effect — for example, medication for pain, even if it may hasten the dying process. This is not suicide or assisted suicide.
Advance Directive Form
A good advance directive form has two parts: a health care power of attorney and a living will. The health care power of attorney allows you name a health care agent (surrogate) to speak for you when you are not able to make or communicate your own decisions. In the living will, you tell your agent what your wishes for health care are when you may be terminally ill, or permanently unconscious, and there is no realistic hope of significant recovery, at a time when you may not be able to make or express your own decisions. (See Page 16 for considerations.)
An excellent form is available at http://www.acba.org/portals/1/pdf/LivingWillPowerofAttorney.pdf. The committee that developed this form was careful to comply with Catholic moral tradition, a tradition which has even provided guidance to courts over the past several decades when the courts were asked to render decisions regarding ventilators and feeding tubes.
Nutrition and Hydration
Supplying nutrition and hydration via tube is medical treatment. You may refuse such medical treatment if it is, or becomes, more burdensome than beneficial.
Over the years, much public press has been given to questions about removing feeding tubes (but not about withholding the treatment). In many cases, the situation was used for political advancement of an individual seeking public office. What was at issue was not the best interest of the patient, but a candidate’s political interest. The Tampa Tribune reported on such an example in its Oct. 23, 2003, issue: “… a Plant City Republican running for U.S. Senate, was featured on cable TV news shows Tuesday, where he described his efforts to save Terri Schiavo. His role in the drama is expected to boost his appeal among Christian conservative voters who have embraced the Schiavo battle and are such faithful voters they can swing the outcome of primary elections.”
Note also public officials who, coincidentally, held, and hoped to continue in, public office, and who intervened in the matter of withdrawing feeding tubes in their jurisdictions: Attorney General William Webster (Nancy Cruzan, Missouri); Governor John Ashcroft (Christine Busalacchi, Missouri); Governor Jim Gilmore (Hugh Finn, Virginia).
In these examples, each patient was in a persistent vegetative state.
This is a form which originated in the state of Oregon. The title is an acronym for Physician Orders for Life Sustaining Treatment. However, in some states, the title is changed. In Pennsylvania, POLST is Pennsylvania Orders for Life Sustaining Treatment. In some states, MOLST is Medical Orders for Life Sustaining Treatment. The form is essentially an advance directive written for you by someone else. It is a very questionable option. Frequently, a patient is asked to sign the form, which is highly improper, as it is a physician’s order.
Absence of Advance Directive
Some states have formalized in law what has been long-standing practice of doctors and hospitals: consult family regarding medical treatment. Frequently, the law specifies the order in which family members are consulted.
Or, someone else will write an advance directive for you, a POLST.
The choice is yours: write your own advance directive, let it be up to your family or rely on POLST. The best choice, obviously, is to write your own.
A will is a document in which you state, in writing, who should be your heirs and receive your assets after your death, and who should be responsible to carry out your wishes in this regard (executor/executrix). Everyone has a will. If you don’t write it yourself, the state writes it for you. When a person dies without a will (intestate), the state law determines to which relative(s) your assets pass. If there are no blood relatives, then the assets would likely go to the state coffers. It is much better to write your own.
FINANCIAL POWER OF ATTORNEY
It is very important to make provision for another person to take care of your assets if it should happen that you can no longer do that for yourself. The state may write a will for you if you do not have a will, but there is no statute that “writes” a power of attorney for you.
If you become incapacitated and have not made provision for someone to manage your assets, then the only alternative is for the court to appoint a guardian for you. This court alternative is intrusive, public and very expensive. It would be good to avoid the court in this matter.
In summary, it is very important for every person to execute an advance directive for health care, a will and a financial power of attorney. This is good stewardship; this is, actually, pro-life.
Mary Traupman has been a Sister of Divine Providence for 60 years. She has been an educator in the Dioceses of Pittsburgh and Greensburg, and in the Archdiocese of Detroit, as well as at LaRoche College and Duquesne University. For a number of years she was an administrator at Divine Providence Hospital and then served in the legal office of Mercy Hospital. She has made over 70 presentations on the subject of health care decision-making and advance directives for health care. Currently, she serves as a member of her order’s elected leadership team while maintaining a part-time private law practice.
|Questions to Answer in Your Advance Directive for Health Care
❏ Do you have any goals that you would especially like to reach if you are in this state — for example, remaining alive for a particular event in the life of a friend or family member?
❏ Do you want to have life-sustaining treatment if you should develop a brain disease or have a brain injury?
❏ Are you an organ donor?
❏ Do you want all treatment to stop, except, of course, treatment for pain?
❏ Do you want to have artificially supplied nutrition and hydration (keep in mind that both nutrition and hydration by tube may increase pain and discomfort, just as taking food by mouth)?
❏ Should your named agent have the last word, or do you want that agent to follow the wording in your advance directive to the letter?