Catholic Q and A- End of Life Medical Decision Making

Q. What are "Advance Directives for Health Care"?
Q. Living Will or Power of Attorney: Which Document is Preferable?
Q. Why Should You Sign a Life-Protective Document?
Q. How do you Choose your Agent?
Q. Upon What Moral Principles Should You Base Important Medical Treatment and Care Decisions?
Q. Is It Ever Morally Permissible to Refuse Food and Fluids?
Q. How Should a Conscientious Medical Professional Respond to a Patient's Refusal of Ordinary/Morally Obligatory Treatment or Care?
Q. Is There a General Moral Guideline to Follow When Making Medial Decisions?

Q. What are "Advance Directives for Health Care"?

A. “Advance Directives” are legal documents which people use to express their wishes regarding medical treatment in the event they become incapable of making their own medical decisions. Many people think that advance planning about medical care is only for those who are very old or very ill. But anyone can be suddenly taken ill or badly injured. It is essential that every person 18 years old or older have an advance directive – but not just any type of advance directive.

The State of Wisconsin recognizes two types of advance directives: the Declaration to Physicians (Living Will) and the Power of Attorney for Health Care (POAHC). While there are specific forms that state agencies must distribute, other forms fulfilling legal requirements are recognized in Wisconsin. Once signed, these forms are legally binding documents.

Before signing any advance directive, it is important to ask yourself: Is this document compatible with the teaching of the Catholic Church? “We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of.” (Catechism of the Catholic Church, 2280)
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Q. Living Will or Power of Attorney: Which Document is Preferable?

A. By signing a Living Will, you authorize an “attending physician” to withhold or withdraw “life-sustaining procedures” under certain circumstances if you are no longer able to make health care decisions for yourself. The attending physician may be a stranger, unfamiliar with your moral principles and wishes, who may interpret your document in ways you did not intend. The law does not require an attending physician to consult your family before stopping treatment. Furthermore, a Living Will is a legal document in which you make medical decisions for some future (currently unknown) illness or injury. Unwittingly, you may “tie the hands” of a physician whose medical expertise could restore you to health.

The most protective and flexible document is a Power of Attorney for Health Care. Signing a POAHC ensures that a trusted family member or friend whom you have personally selected (your “agent”) will make health care decisions for you if you are ever unable to do so. Your agent will make decisions based on knowledge of your actual condition and treatment options, in light of your personal wishes and moral principles.

Both the Living Will form and the POAHC form provided by the State of Wisconsin permit euthanasia by omission. The Catholic Church teaches that “whatever its motives or means” euthanasia “is morally unacceptable” and “constitutes a murder.” The Church defines euthanasia as “an act or omission which, of itself or by intention, causes death in order to eliminate suffering.” (Catechism of the Catholic Church, 2277) It is up to you to ensure that your advance directive does not permit euthanasia.

To meet this problem, a number of organizations that fully respect human life have prepared life-protective POAHC forms that are in accord with Catholic moral teaching. I recommend two such forms that are state-specific: the Protective Power of Attorney for Health Care1 prepared by Pro-Life Wisconsin and the Wisconsin Protective Medical Decisions Document2 prepared by the International Task Force on Euthanasia and Assisted Suicide.

[1] Available (free) from Pro-Life Wisconsin, 1-877-GOD’S WILL (1-877-462-7945). You can view and download the POAHC here.
[2] Available ($10.00 donation suggested) from the International Task Force, P.O. Box 760, Steubenville, OH 43952; 1-740-282-3810
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Q. Why Should You Sign a Life-Protective Document?

A. Unfortunately, many in our society no longer see the difference between allowing a person to die when no treatment or care can sustain his/her life and intentionally killing a person by an omission or an action. Euthanasia by omission is already commonly practiced, and there is a movement underway to add euthanasia by lethal injection and assisted suicide (already legal in Oregon) to end-of-life choices. Therefore, it is important to make it unmistakably clear in your POAHC that you reject euthanasia and assisted suicide.

Every patient entering a health care facility is asked, “Have you signed a Living Will or Power of Attorney for Health Care?” This is because the federal Patient Self-Determination Act of 1990 requires hospitals and health care programs to give people information about advance directives. Consequently, you will most likely be given a Living Will or POAHC to sign during admission procedures, a time when most people are under stress and distracted by other paperwork. It is not a good time to be considering a legal document which may determine whether you live or die. Be prepared. Always bring along your completed life-protective POAHC.
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Q. How do you Choose your Agent?

A. Your Power of Attorney document is only as good as your health care agent. Therefore, it is of utmost importance that you appoint someone who:

Be aware that Wisconsin law does not permit certain people to be named as your agent. If you are not using a state-specific form, consult the law.

You should discuss your wishes and moral principles in detail with your agent when you sign your document and periodically thereafter. Many people are not comfortable talking about aging, illness, and dying. However, as difficult as it may be to discuss such issues ahead of time, during a medical crisis it may be even more difficult.
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Q. Upon What Moral Principles Should You Base Important Medical Treatment and Care Decisions?

A. You are morally obligated to accept ordinary medical treatment and care that sustain life, maintain health, or cure or improve your condition. Ordinary medical means are those which are routine, available, and beneficial. Pain relief and comfort care also fall into the category of ordinary means which should be provided to all patients as needed.

Extraordinary medical treatment is non-obligatory, that is, you may accept or refuse it. It is medical treatment that is unduly burdensome or risky. The physician should discuss the risks and burdensomeness of a particular treatment with you/your agent. However, it must always be you or your agent who decides whether or not you want a particular treatment that is judged extraordinary. And it must be the particular treatment that is burdensome, not your life that is the burden to you or others. When in doubt, err on the side of life.

Consider this thought from a Catholic physician friend of mine:

Ordinary means are done to protect and preserve life. Extraordinary means are done because an extraordinary creature (person) has an extraordinary illness. When an effective extraordinary treatment is available, shouldn't a patient get it in order to live the life span given to them by God?

For more information, consult the Catechism of the Catholic Church, paragraphs 2278 and 2279.
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Q. Is It Ever Morally Permissible to Refuse Food and Fluids?

A. Provision of Nutrition and Hydration is ordinary care, not medical treatment. Food and fluids do not become medical “treatment” simply because they are taken by tube any more than penicillin or Pepto-Bismol becomes “food” when taken by mouth. Food and fluids are generally morally obligatory.

When Archbishop Raymond L. Burke was the Bishop of La Crosse, he issued this statement in defense of a brain-damaged, but otherwise healthy woman’s life:

We presume in favor of nutrition and hydration because food and water are ordinary means of keeping anyone alive, even if this is done through a feeding tube. If Mrs. Schiavo were facing imminent death, or were unable to receive food and water without harm, then removing nutrition and hydration would be morally permissible. It is however never permissible to remove food and water to cause death. Food and water are basic human needs, and therefore basic human rights.

Archbishop Burke clearly and simply stated the basic guidelines for making moral decisions regarding nutrition and hydration. If you follow these guidelines, you will not go astray.

Unfortunately, both the Wisconsin Living Will form and POAHC form allow people to refuse a feeding tube when food and fluids would sustain their lives. This omission constitutes euthanasia or assisted suicide. Under Wisconsin law, if a patient has signed an advance directive that requires ending tube-feeding under specified circumstances, medical professionals would be expected to comply.
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Q. How Should a Conscientious Medical Professional Respond to a Patient's Refusal of Ordinary/Morally Obligatory Treatment or Care?

A. If a patient or a patient’s agent decides to refuse ordinary treatment or care, there may, in some instances, be little that the medical professional can do to prevent this. However, there remains the duty to attempt to persuade the patient otherwise or, failing that, for the physician or other professional to remove himself/herself from the case so as not to be guilty of complicity in euthanasia or suicide.
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Q. Is There a General Moral Guideline to Follow When Making Medial Decisions?

A. Whenever a decision is made to withhold or withdraw a particular form of treatment or care, it is most important to examine intent. Is the intention to hasten or cause death? Then the action or omission is always wrong.

One final note: Spiritual preparation for death often is not given enough consideration. By spending so much space on medical decision-making, I do not wish to imply that this is more important than spiritual preparation for death. In fact, both are essential elements in preparing for death and for life after death. As Christians who trust in the promise of eternal life, we know that death does not have the final word.
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Julie Grimstad

Julie Grimstad, a member of St. Peter’s Church, is the executive director of Life is Worth Living, Inc., a member of Pro-Life Wisconsin’s speakers bureau, on the Human Life Alliance board of advisors, and a member of the Respect Life Committee of the Diocese of La Crosse.

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