DNR's and Living Wills

[turtlegirl1980]

What is the Catholic stance on DNR’s and Living Wills? How much can I tell a healthcare provider to not do? Such as withholding or withdrawing treatment? Does the Catholic church follow the whole brain definition of death or the partial brain death definition?

Thank you.

 

[empther]

Pope Pius XII told a group of anesthesiologists that we are not required to use unnatural means to extend life.

That has been the Church’s position. It leaves people options.

Artificial resuscitation leaves the patient permanentely damaged 85% of the time.
Leave me alone!

 

[JRKH]

What is the Catholic stance on DNR’s and Living Wills?

The Church has no problem with either one.

How much can I tell a healthcare provider to not do? Such as withholding or withdrawing treatment?

This gets a bit complicated depending on the particulars. As a rule of thumb however I believe that 'treatments withheld" are not generally a problem. Treatments started but then desired to stop can be different…

Does the Catholic church follow the whole brain definition of death or the partial brain death definition?

Peace
James

 

[TS_Aquinas]

Does the Catholic church follow the whole brain definition of death or the partial brain death definition?

Thank you.

Speculations of Bl. JPII held the person is dead after brain death, this is under review again under a commission called by Pope Benedict of theologians, neuroscientists and philosophers (particularly, those that specialize in philosophy of mind.) If they will adhere to Thomistic dualism (hylemorphic dualism), which is the stance of the Church, then the ruling will be that the person is not dead after brain death. If they rule otherwise, it’s going to get ugly in the philosophical arena on this issue. But from the latest I can find, the position has swayed away from that of Bl. JPII to “uncertainty.”

 

[turtlegirl1980]

Thank you for your help!

 

[GratefulFred]

A natural means to sustain life is nutrition. We must always feed and hydrate the ill.

I am not sure if that means we have to INSERT feeding tubes when they no longer can swallow - the natural way to take in food and water - but I do think it means that once inserted we cannot remove them.

When a loved one is no longer able to communicate, we cannot tell what they are thinking. I believe in God and cannot discount the possibility that this 'quiet time" is time being spent to sort things out. So I want to be sure that I am not hastening death. (This important idea is also why I am against the death penalty.)

We have Living Wills. The closest loved one gets to make the call. I hope that at that time, they will be in close consultation with a priest. So much turns on the facts in each individual case. At that most important point in time I will really need the advice of a good priest.

 

[Rence]

A natural means to sustain life is nutrition. We must always feed and hydrate the ill.

I am not sure if that means we have to INSERT feeding tubes when they no longer can swallow - the natural way to take in food and water - but I do think it means that once inserted we cannot remove them.
.

You can remove it if it’s causing a hardship to the patient. If the patient is unable to process the food and water, and it’s doing more harm than good, then you can remove it. Same for IV fluids that are causing fluid overload instead of being used.

 

[GratefulFred]

I would add that Living Wills are virtually a MUST these days.

Hospitals have to guard against mal-practice law suits. They are duty bound to proceed according to THE patience’s desires. If THE patient cannot speak, they are duty bound to use all appropriate medical procedures. The ONLY way to prevent the horrid stories is for THE Patient to have a proper Living Will in place.

 

[GratefulFred]

Rence: Makes sense. I did not think of that. Thanks. More reason why consulting with a good priest is wise, IMO. We cannot think of everything at the time we need to.

 

[JimG]

I would add that Living Wills are virtually a MUST these days.

Hospitals have to guard against mal-practice law suits. They are duty bound to proceed according to THE patience’s desires. If THE patient cannot speak, they are duty bound to use all appropriate medical procedures. The ONLY way to prevent the horrid stories is for THE Patient to have a proper Living Will in place.

This is true. But I just don’t like the practice. It’s rather disconcerting when the first thing a hospital admitting nurse asks about is your living will. It’s like saying, okay you’re here, now what shall we do if you’re about to die? Not a promising start.

Further, it essentially asks the patient to make medical decisions about future possibilities without knowing all the facts. Yes, resuscitate me if there’s hope of recovery. No, you don’t need to if it’s useless. It’s not always an either / or decision; a lot depends on specific medical facts at the time. Ethical physicians ought to be in a better position to judge this at the moment, as long as they keep in mind that the patient before them is their primary patient, not someone on the kidney waiting list.

 

[JRKH]

I want to second the matter re: nutrition.
My father passed from advanced Alzheimer’s disease and the decision was made NOT to insert any apparatus. This was supported by his pastor and by the hospice workers (in home) who stated that once things got to this point that his body was shutting down and that he would not be able to properly process and evacuate the (name removed by moderator)ut anyway.
My wife and I have made the same decision. She is DNR and no “extraordinary measures”.

It’s a tough way to watch a loved one go, but when things reach a certain point, it’s better to just let them go home to Jesus…

Peace
James

 

[Rence]

This is true. But I just don’t like the practice. It’s rather disconcerting when the first thing a hospital admitting nurse asks about is your living will. It’s like saying, okay you’re here, now what shall we do if you’re about to die? Not a promising start.

Further, it essentially asks the patient to make medical decisions about future possibilities without knowing all the facts. Yes, resuscitate me if there’s hope of recovery. No, you don’t need to if it’s useless. It’s not always an either / or decision; a lot depends on specific medical facts at the time. Ethical physicians ought to be in a better position to judge this at the moment, as long as they keep in mind that the patient before them is their primary patient, not someone on the kidney waiting list.

A living will will prevent the staff of an emergency room from trying to recuscitate you for 2 hours after you’ve coded, at the insistence of your family, as what happened to a patient in the ER last year. Without a living will, family members can sue a hospital for not continuing CPR after a patient has coded. Yes, physicians ought to know when it’s time to stop, but that doesn’t stop family members who, in the heat of the moment, insist they know better. You need to have it in writing (for your own protection, as well as the hospital staff) that you don’t want attempts made to be resuscitated if it’s useless.

 

[JimG]

A living will will prevent the staff of an emergency room from trying to recuscitate you for 2 hours after you’ve coded, at the insistence of your family, as what happened to a patient in the ER last year. Without a living will, family members can sue a hospital for not continuing CPR after a patient has coded. Yes, physicians ought to know when it’s time to stop, but that doesn’t stop family members who, in the heat of the moment, insist they know better. You need to have it in writing (for your own protection, as well as the hospital staff) that you don’t want attempts made to be resuscitated if it’s useless.

I understand. It just seems odd to be giving personal medical directives in just this one instance, while in nearly every other instance of medical judgement, one tends to let medical professionals make the call. I do not, for example, give prior directives to my surgeon for every possible contingency which might occur during surgery.

 

[Rence]

I understand. It just seems odd to be giving personal medical directives in just this one instance, while in nearly every other instance of medical judgement, one tends to let medical professionals make the call. I do not, for example, give prior directives to my surgeon for every possible contingency which might occur during surgery.

It’s because in nearly every other instance, the patient is competent and can consent or refuse the treatment ordered by the medical professional. When the patient is not able to speak for themselves, the family gets involved and in the heat of the moment, they may not consider what the patient would want or think they know what the patient would want.

Another example would be if a patient has in their lifetime told their family about their adversion to respirators. However being put on a respirator because one is terminally ill, or fatally injured is NOT the same as being put on a respirator because someone went bad while having pneumonia, or has had an accident that leaves them with temporary help, or are temporarily in respiratory distress. So potentially, a person can arrive to the emergency room with family in tow, and need to be intubated for a few days, but the family will refuse out of fear and lack of knowledge, and the person will be lost prematurely.

A living will can sort that out so that if a patient is currently not able to make a decision, that the physicians can do it for them, based on the patient’s written wishes. A patient who is incapacitated for any reason, is just simply not in a position to consent or refuse treatment. So the next of kin does that if a living will or advanced directive is not in place. They’re very important.

 

[turtlegirl1980]

Thank you guys. I am trying to get all my ducks in a row before I go to the legal office. I also agree that I need to make an appointment with my priest before I sign anything.

Peace,
Natasha