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.