You check into a hospital for a routine procedure. They ask you if you have a living will. You say no. They slide a form in front of you with simplistic questions such as: Do you want to be resuscitated if you go into cardiac arrest? Do you want mechanical ventilation if you are unable to breath? Do you want nutrients and fluids supplied to your body if you’re unconscious?
Your gut tells you the questions are superficial. If CPR could revive you and you could live decently for a while longer, yes, you’d want it. If you’d die anyway an hour later, then no. If ventilation was a temporary measure to help you overcome an acute condition, yes. If you were permanently unconscious and never able to breathe again on our own, then perhaps no. And food and water? Of course you want to be fed. What’s the alternative, starvation?
You don’t get much help from the check-in clerk. And hospital healthcare managers give you ideologically-laden advice such as “think about your values…and what you feel would make your life not worth living” (from the Mayo Clinic website). “Life not worth living!?,” you ask, “Where does that idea come from? Not from Catholic faith.”
But you recall that your Aunt Agatha didn’t have an Advance Directive and she was subjected to aggressive and obviously-futile treatments at the end of her life and suffered unnecessarily. You’re pretty sure that if she’d been asked she’d have said: “Enough’s enough. Let me go to God!” But she was unconscious. You fear that if you don’t fill out the form, something like this might happen to you. What should you do?
Advice for Catholics: If you can avoid using Living Wills and POLST (MOST) forms, by all means do so. Their simplistic check-box format poses unacceptable risks from both the perspective of good medical decision-making and good ethical decision-making. They risk binding the hands of medical professionals to non-treatment decisions that are not in the best interests of patients.
But this does not mean that Catholics should be unprepared for end-of-life crises. I recommend that all Catholics who are able should do the following three things:
First, execute in writing a Health Care Power of Attorney (HCPA) assigning a proxy decision maker—sometimes called a “surrogate”—to act as your healthcare agent in the event that you become incapable of making informed decisions. You can do this yourself without costly legal fees. Just make sure that your HCPA is adequately specific and your signature is validly witnessed. Here are a few things you might include.
Invest your proxy with full authority to make healthcare decisions on your behalf, including but not limited to the power to:
(1) consent to, or refuse, or withdraw consent to, any type of medical care, treatment, surgical procedure, diagnostic procedure, medication and the use of mechanical or other procedures that affect any bodily function, including, in appropriate circumstances, life-sustaining procedures. [*Note: this power does not extend to the refusing of properly “ordinary means” of care, defined in Catholic teaching as forms of care or treatment that promise a “reasonable hope of benefit” and are “not excessively burdensome.” The Catholic Church teaches that the administration of food and water is always ordinary care unless and until one’s body no longer can assimilate them, at which time their administration becomes futile and is no longer obligatory];
(2) request, receive, and review any information regarding your physical or mental health, including but not limited to medical, hospital and other records; and to consent to or authorize the use and disclosure of such information;
(3) employ and discharge your health care providers;
(4) authorize your admission to or discharge (including transfer to another facility) from any hospital, hospice, nursing home, assisted living facility or other medical care facility;
(5) authorize that you be discharged from a medical facility and be brought home and cared for at home;
(6) take any lawful actions necessary to carry out these decisions.
You may also want to state that the authority of your agent is subject to no limitation except the law of God, the authoritative teaching of the Catholic Church, and your agent’s own conscience.
Second, ensure that your proxy not only is willing to direct all relevant medical decisions in accord with Catholic faith and morals, but understands what doing so means. Frequently the limiting factor in legal disputes over end-of-life decisions comes down to uncertainty of the wishes of the patient. Remove all uncertainty. Make your wishes known both orally and in writing as clearly as possible to your proxy and to other loved ones.
If you are uncertain about Church teaching on end-of-life decision-making, speak to your parish priest, or an informed Catholic medical professional, or contact trustworthy groups like the Catholic Medical Association, or your diocesan moral theologian, or, if nothing else is available, directly contact your local bishop.
Third, in the event that you or your proxy are faced with a situation in which the judgment of a hospital ethics committee or other hospital decision makers seems to conflict with your faith or morals, don’t be afraid to mount a legal challenge in court. If you are reticent because of the cost of legal representation, consult with a reliable Christian advocacy ministry such as Alliance Defending Freedom, Christian Legal Society, and American Center for Law and Justice. You might even contact one of the 50 state affiliates of National Right to Life.
Some might find it difficult or even repugnant to initiate a forthright conversation with a loved one about treatment plans at the end of life. I urge you to overcome this resistance. Because a large majority of medical resources in U.S. healthcare are consumed on end-of-life treatments for the elderly, secular medicine, fueled by Obamacare, and with the support of the medical insurance industry, is investing enormous energy in publicizing and distributing secular tools for end-of-life decision making. The tools are invariably skewed in the direction of refusal of life sustaining treatments. Although flagrant examples of aggressive overtreatment still exist, U.S. healthcare is travelling rapidly and ineluctably in the direction of a culture of refusal. Without conscientious advance planning, some will find the pressure to check the “refusal” box on these documents hard to resist.
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Christian Brugger is Senior Fellow of Ethics at the Culture of Life Foundation in Washington, DC, and Cardinal Stafford Professor of Moral Theology at St. John Vianney Theological Seminary in Denver.
[Readers may send questions regarding bioethics to zenitbioethics{at}gmail.com. The text should include your initials, your city and state, province or country. The fellows at the Culture of Life Foundation will answer a select number of the questions that arrive.]
