Living wills and durable powers of attorney for health care are what we call advance directives — attempts to leave instructions to others in case you become terminally ill or permanently unconscious and unable to make medical decisions or speak for yourself. Like it or not, you probably can’t avoid these documents because federal law requires that a hospital ask you on admission whether you have signed an advance directive and present you with one if you so desire. Also most people are presented with these documents when doing estate planning. From a legal perspective, you do not have to sign them in either case.
It is interesting, however, that most of these documents address concern for over-treatment when in reality we’re in an era of health care cost cutting and greater possibility of being denied treatment. We also are dealing with an active euthanasia movement pushing for physician-assisted suicide in many state legislatures and the courts, frequent inappropriate withdrawal of nutrition and hydration, and even the use of terminal sedation to hurry or cause death. If treatment you need will not bring about a full recovery, or if you are disabled or elderly, perhaps your greater concern will to obtain the care you need.
The National Catholic Bioethics Center (NCBC) says that “[t]he usefulness of an Advance Directive, which gives specific instructions for care, is limited because of its inflexibility. If circumstances change significantly between writing the Advance Directive and its implementation, the instructions may be of little value to those acting on a patient’s behalf, or may even hinder their freedom to make good decisions. There may also be a problem of interpreting the document when it is not clearly written. An Advance Directive oftentimes does not allow for adequate informed consent because one must make a decision about a future medical condition which cannot be known in advance.”
When it comes to end-of-life health care, the NCBC favors the use of durable power of attorney in part “because it leaves decisions in the hands of someone whom the patient has personally chosen,” and who “can be more sensitive and responsive to the decision-making that is necessary for a given case.”
Priests for Life founder Father Frank Pavone concurs, concluding that making specific decisions legally binding in an advance directive is not morally justified, thus “living wills” are both unnecessary and dangerous. He does however support the durable power of attorney for health care. If you’re going to leave more specific instructions, Father Pavone recommends the pro-life “Will to Live” (available at nrlc.org), because it attempts to avoid some of the common defects of other advance health care directives and contains a presumption for life and for the provision of medical treatment and palliative care.
Virtually all advance directives (other than the Will to Live) can be interpreted to allow the withdrawal of food and water unless you clearly specify otherwise in the document. In some states, like California, food and water is legally considered medical care. However, Pope John Paul II strongly stated that and affirmed that “the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory…”
You may need to know about a more recent type of health care directive termed with various acronyms such as POLST or MOST (Physician or Medical Orders for Scope of Treatment). A doctor or his representative, even when you are not terminally ill or in crisis, may ask you a check list of questions to fill out a one-page form regarding important medical orders such as “do not resuscitate,” “allow natural death,” “withhold nutrition and hydration — or antibiotics.”
Whatever is checked is immediately actionable, might override advance directives you already have in place, and is meant to stay in your chart so that it may be executed at a later time by a different doctor. About these, the Catholic bishops of Wisconsin said, “Because we cannot predict the future, it is difficult to determine in advance whether specific medical treatments, from an ethical perspective, are absolutely necessary or optional. POLST oversimplifies these decisions and bears the real risk that an indication may be made on it to withhold a treatment that, in particular circumstances might be an act of euthanasia.”
Several articles from the National Catholic Bioethics Center indicate that they agree and recommend that Catholic health care institutions refuse to accept them unless they are revised to comport with Catholic ethical and religious directives.
In a nutshell, while it is permissible to sign advance health care directives, as long as they do not contradict Catholic teaching on medical care related to death and dying, most of them are problematic. You might want to consider simply using a durable power of attorney for health care such as the one included with the Will to Live, or if you trust, leave these decisions to your spouse, parents or adult children, who, in that order, would be considered the ones to hold that responsibility in most states.
The writer was a pro-life lobbyist for 22 years with the National Right to Life Committee. She is also a parishioner at St. Elizabeth Ann Seton Church in Anchorage.