Catholic Pro-Life Advanced Directives

[JesuXPIPassio]

Hey everyone.

I was wondering, is there any of you out there who could teach me about Advanced Directives for us Catholics? My field of study in the Church is political science; I’m not much of a theologian. I’m very pro-life, but I know more about the abortion side than the Advanced Directives side of it. I’m doing this because I’m making out my living will (I’m just 24, but you never know) plus I want to help others make out their Advanced Directives.

I’m particularly wondering what our stances are for cases where the person is unable to eat or drink anymore. From what I understand, we are to provide healthcare insofar as it is naturally-expected. But if a person is no longer able to naturally consume food, are artificial means for nourishment necessary? Also, since from what I understand it is okay to refuse treatment, in the case where I am not naturally able to consume food or something, can I refuse to take artificial nourishment? This is what confused me about the Schiavo thing.

Please also help me out with good sources, documents from the Vatican, etc. I’m having difficulty navigating through this all myself. My theological skills leave a lot to be desired.

 

[nodito]

There is a great site by the National Catholic Bioethics Center that fleshes out some of the Church’s teachings in this area: ncbcenter.org/eol.asp :

"Generally, a medical procedure that carries with it little hope of benefit and is burdensome is deemed “extraordinary” and is not obligatory. For example, a person may judge in good conscience that the pain and difficulty of an aggressive treatment for terminal cancer is too much to bear, and thus decide to forgo that treatment. Whether a particular treatment is excessively burdensome to an individual patient is a moral question that often requires the advice of a priest or someone well-trained in moral theology.

“When death is imminent one may refuse forms of treatment that would only result in a precarious and burdensome prolongation of life. There is a presumption in favor of continuing to provide food and water to the patient, but there is a stage in the dying process when even these may no longer be obligatory because they provide no benefit. Normal care always remains morally obligatory, but refusal of additional treatment when death is imminent is not equivalent to suicide. It should be seen instead as an expression of profound Christian hope in the life that is to come. An instruction not to provide such treatment, when communicated ahead of time to family and friends, may give great comfort to loved ones during emotionally stressful times.”

It’s important to note that the Church makes a distinction between imminent death and quality of life, especially when discussing whether to stop providing food and water. For example, if at the end of one’s life, a person’s body stops manufacturing albumin, which is necessary for regulating distribution of fluids in the person’s body, it may be licitly decided to discontinue feeding because the feeding itself could cause harm (i.e., cause the person’s arms to swell, skin to rupture, infection, etc.), and because death is imminent. But in the case of Terri Schiavo, the Church spoke out strongly against withholding food and water because all people are entitled to food and water (even if they can’t consume it in the normal way) and Terri wasn’t dying. The fact that she was living with a reduced quality of life (by our standards) is irrelevant, because a person’s right to life and food and water is not dependent on their ability to walk, or talk, or reason. (Consequently, this is also the Church’s argument against abortion).

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[nodito]

This website also has a fair bit written about advance directives in general. It seems that they favor assigning a proxy to act on your behalf rather than a static document that might not take into consideration all aspects of a medical situation. Food for thought.

"Make certain that your Advance Directive forbids any action that the Catholic faith considers to be immoral, such as euthanasia or physician-assisted suicide. A Catholic hospital, in any case, will not follow a directive that conflicts with Church teaching (ERD #24). Once a directive is made, copies should be distributed to the agent and anyone else the patient deems appropriate. One should periodically review the provisions of an Advance Directive and, when there is a revision, all previous copies should be destroyed.

"The 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 drawing up an Advance Directive, therefore, one should focus on general goals rather than on specific medical procedures.

“Assigning Durable Power of Attorney is preferable to an Advance Directive because it leaves decisions in the hands of someone whom the patient has personally chosen. A proxy agent also can be more sensitive and responsive to the decision-making that is necessary for a given case. When assigning Durable Power of Attorney one should choose an agent of good moral character—someone who is known to be capable of making sound decisions under stressful circumstances. The agent should know the teachings of the Church and possess the practical wisdom to apply them to changing circumstances. An agent, of course, must also survive the patient. One may designate alternate agents in case one’s first choice, for some reason, is unable to act.”

 

[JesuXPIPassio]

Was this helpful?

Oh, absolutely. Thanks so much for your help. I still have to really go through this and absorb it better; I wanna make sure I have it down properly. It’s more complicated than I thought. I didn’t even know we had a bioethics centre.

 

[MissMichal]

It is possible to have both a Living Will and a Special Power of Attorney. The Living Will serves the function of laying out exactly what your preferences are, and the person with power of attorney can make decisions for you if there’s a decision to be made that isn’t covered in your Living Will. Both protect you in case of a Terri Schiavo-like case comes up where the family is fighting over what to do, because no one is guessing what you would have wanted. It’s important to find out which form trumps which–in Utah, the person with power of attorney can make decisions that are contrary to the living will. That said, if your living will says specifically that you do not want treatment withheld and your POA wants to withhold it, the medical staff and the court are more likely to fight that decision.

Forms for Utah and Idaho are given at the Intermountain Healthcare site, and there’s a great guide to discussing your wishes with your family. The forms are easy to fill out, and even if they’re not the right forms for your state, they will serve the function of making your wishes known in case you get hit by a bus before you find the right form. There are also lots of lawyers out there who will help you put these together.