Tag Archives: living will

Follow Church prescription for a Catholic living will

Living wills were first introduced by the Euthanasia Society of America in 1967, and were popularized by one of its members, advice columnist Abigail Van Buren (“Dear Abby”). Given the disreputable history of the living will, Catholic patients should ensure that end-of-life documents follow Church teaching. Living wills do not become activated until patients cannot speak personally to express their desires. Health care surrogates, usually family members, need to be assigned to speak for the patients then. A Catholic living will should also address the following 5 principles, to avoid the dangers of secular end-of life documents.

1. Relieving pain. Church teaching strongly supports patients being kept as free of pain as possible. This needs to be balanced with patients’ moral and family duties as they prepare with full consciousness to meet Christ.

2. Assessing treatments as ordinary or extraordinary. Patients and their families need to be given adequate information for a clear understanding of any end-of-life treatment. Is each treatment: 1) serving as a bridge to recovery from an acute medical problem, 2) alleviating suffering from an ongoing condition, or 3) offering little hope of benefit and actually becoming burdensome? There is no obligation to accept extraordinary treatments that have significant risks which may outweigh benefits.

3. Providing food and nutrition. A written request for receiving food and water, even if by artificial means, is generally not included in a standard secular living will that views assisted nutrition and hydration as medical treatment, but the Catholic Church views assisted nutrition and hydration as normal care. Pope St. John Paul II wrote:

“The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act.”

When a terminally ill patient, however, is at the brink of death, body systems are shutting down and can no longer digest food. At this point assisted hydration and nutrition become burdensome and could be discontinued.

4. Prohibiting euthanasia. The immorality of Euthanasia and Physician-Assisted Suicide (PAS) predates Christianity, as Hippocrates prohibited this practice 2,400 years ago. The Catholic Church has always taught that these are grave violations of God’s law. In an age where PAS is being legalized, it is important to clearly state an opposition to this misguided autonomy and false mercy.

5. Requesting spiritual care. This provision asserts that a priest be notified and that the Sacraments be given. The Sacraments of Penance, Anointing of the Sick, and Viaticum are the healing Sacraments that give peace, strength, and grace in preparation for death. The Anointing of the Sick unites a person more closely to Christ’s Passion and uses suffering as a participation in His saving work.

A Catholic living will that includes these 5 principles — and a designated surrogate committed to Catholic principles to speak when the patient cannot — serves not only the patient’s own well-being, but also acts as a tool for evangelization by witnessing to the truth about human dignity, the redemptive value of suffering, and hope in eternal life. For a model Catholic end-of-life document: https://www. flacathconf.org/documents/2018/11/CDLD.pdf

Dr. PETER MORROW is the immediate past-president of the Catholic Medical Association, and practices geriatric medicine in Saint Cloud, Florida.

Advance Directives for peace of mind

Life is to be enjoyed and the thought that we may one day face a sudden health crisis due to an accident or serious illness can be very scary. What if you are unable to make your own medical decisions? Who will make these decisions for you? Will they make the same choices you would make? Fortunately, there is a legal means to addressing this potential future concern — it’s called an Advance Directive.

Susan Locke

Susan Locke

An Advance Directive is a written statement that you complete in advance of a serious illness. Within this document you will name someone to act on your behalf or you will outline how you want medical decisions to be made when you are no longer able to make decisions for yourself.

There are several advantages to communicating your wishes about treatment. You will have the opportunity to make very personal health care decisions. You will prevent arguments and you will spare loved ones from the anxiety of having to guess your wishes.

There are two types of Advance Directives and it is important to have both kinds.

1) LIVING WILL: This document specifically spells out what types of treatment you want at the end of your life or if you are unable to speak for yourself. It may include decisions about:

• The use of Cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Do you want extraordinary measures taken or do you prefer a Do Not Resuscitate order (DNR) which is a request not to have CPR?

• The use of breathing machines (mechanical ventilation) and/or dialysis

• Sustainment by tube feeding

• Organ and tissue donation preferences

2) HEALTH CARE POWER OF ATTORNEY: This document appoints someone to make health decisions if you can’t communicate on your own. The person you designate as your Health Care Power of Attorney, also known as a Health Care Proxy, is your advocate, not only concerning life-prolonging treatments, but also for other medical treatments. This is different from a regular Durable Power of Attorney which covers financial matters.

Your Health Care Power of Attorney should be someone who knows you well and someone who is willing to carry out your directions regardless of personal feelings or influence of family and friends. An alternative Health Care Power of Attorney should also be named.

Advance Directive forms may vary slightly from state to state. State-specific forms are available on the AARP website. Your physician should also have these forms available for you to complete.

Copies of Advance Directive forms should be kept by your Health Care Proxy and given to your physician to become part of your medical record.

You can change or cancel your Advance Directives at any time, if you are considered of sound mind. These changes should be signed and notarized. Inform your doctor and family members that you have made changes to these directives.

SUSAN LOCKE is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

Making tough end-of-life decisions

John Haas writes that Catholics should be equipped to address end-of-life questions . . .

Dr. John Haas

The National Catholic Bioethics Center provides over 1,400 consultations in a given year. Without a doubt, the issue most often raised with our ethicists has to do with making difficult, sometimes heart-wrenching, decisions at the end of life.

Catholics, however, should be the best equipped to address these challenges calmly. After all, we know that our final destiny lies not here but in the life beyond the grave. Also, how many times a day do we bring up our own death when we pray the Hail Mary? And then there’s the wonderful Catholic devotion of praying to St. Joseph for a holy death.

Nonetheless, when we face the challenge of making decisions for our loved ones, it can be very difficult. We don’t want them to suffer on the one hand, and we don’t want to lose them on the other. We’re also sometimes conflicted because we don’t know exactly what the Church would have us do.

Because of our love for life, many Catholics think the Church insists that we use every means available to keep someone alive as long as possible. This is not the case. The U.S. bishops have issued a guide known as The Ethical and Religious Directives for Catholic Health Care Services. This useful document, however, cannot tell Catholics exactly what must be done in every situation. Decisions must be taken in each individual case — and there are countless details that can enter into each situation.

For this reason, the Church generally discourages the use of a “living will” or “advance medical directive” which presume to state what one wants at the end of life (for example, “I do not want tubes”). However, one cannot know ahead of time whether the “tube” will alleviate suffering or assist in significantly extending one’s life. This is why we at the Center encourage people to designate a “health care proxy,” someone to make decisions on their behalf when they’re no longer able to do so.

One time I received a “living will” from a parish priest who asked me to read through it to see if it was ethically sound. He had written 27 pages, single-spaced, about what medical interventions ought to be taken if this or that happened. I wrote him back and said, “Father, I have one criticism of your living will: It’s not long enough!” It was not long enough because we simply cannot anticipate all the problems that could arise. That’s why it’s better to designate a trusted friend or family member who can make such decisions when you can’t.

But what about some specific advice our tradition can give us? Directive 56 of the Directives reads: “A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.” This is a very helpful guideline for Catholics, and it’s obvious that the facts of the case can vary with each individual.

It’s important to note that the judgment with respect to what would constitute an excessive burden or an excessive expense rests with the patient. It might be that the patient simply doesn’t believe that an experimental cancer treatment which has terrible side-effects and which might extend his or her life for two months offers a “reasonable hope of benefit.”

Or the patient might prefer that family resources be used to send his last child to college rather than be used on an experimental treatment. This ought to be a judgment made by the patient, not by an insurance company or a governmental agency!

And one step we should certainly take near the end of our earthly pilgrimage is to call a priest to bring the comfort and joy of the sacraments of Reconciliation and Anointing.

The bishops’ Directives remind us that we must ultimately be prepared for eternity. “The dignity of human life flows from creation in the image of God, from redemption by Jesus Christ, and from our common destiny to share a life with God beyond all corruption.” The only thing that could risk the loss of that shared destiny is sin.

The bishops’ Directives are available at the USCCB website or through The National Catholic Bioethics Center. The Center also provides the simple and easy to understand Catholic Guide to End of Life Decisions, which includes a form for an “advance medical directive” or the designation of a “health care proxy” which conforms to Catholic moral teaching.

John M. Haas, PH.D., is president of the National Catholic Bioethics Center and founding president of the International Institute for Culture. He is a member of the Pontifical Academy for Life.