By Marty Denzer
Catholic Key Reporter
KANSAS CITY — As baby-boomers age, they often find themselves either caring for or making decisions for the care of a parent as they themselves are facing actual or eventual care needs. The Catholic Church remains a stalwart of protection for vulnerable individuals in society. In his 1995 encyclical letter, Evangelium Vitae, The Gospel of Life, Pope John Paul II gave an alarm by stating that surrounded by a culture that congratulates itself on being enlightened and progressive on human rights issues, Catholics are very much in danger of giving in to a “culture of death.”
For the past three years, the diocesan Respect Life Office has recognized the need for a document to educate Catholics in the diocese about end-of-life issues and assist them with end-of-life healthcare decision-making.
“There has always been a need for information and guidance on Church teaching that is also consistent with Missouri state law,” said Bill Francis, director of the Respect Life Office, “a need made even more critical in recent years due to activities in the healthcare industry, changes in state laws and misinformation from ill-informed sources.”
The Missouri Catholic Conference recently introduced a new Durable Power of Attorney for Healthcare (DPOA-HC). The document was developed by the MCC, with assistance of the National Catholic Bioethics Center, local Catholic attorneys, the Thomas More Society and the Kansas City-St. Joseph diocesan Respect Life Office. The document was approved by the bishops leading all four Missouri dioceses.
When it is time to make decisions about medical treatments, either for ourselves or for family members or close friends, to make those decisions in accordance with the Catholic faith, take all factors — risks and benefits, alternatives, conditions, prognosis, costs and all possible burdens on the patient, family and the community — into consideration. Determining if and when a particular treatment can be withheld or stopped morally should be done with all the people involved — the patient, the Durable Power of Attorney for Health care if the patient is incapacitated, family members, health care providers and often a priest or Catholic ethicist. All such decisions are moral decisions and must be made with informed consent.
Planning in advance can ensure that a person’s wishes about medical treatments and religious beliefs are known and honored should there come a time when their ability to reason and/or to communicate is compromised. Advance directives are legal documents that take effect when a patient becomes incapable of making medical decisions.
You may have been hospitalized or a patient’s next of kin, and been asked about advance directives. Federal law requires all hospitals and health care facilities to advise patients upon admission of their right to accept or refuse treatment and the right to issue advance directives. Missourians have the option of preparing a Durable Power of Attorney-Health Care or an advance Declaration concerning “death-prolonging” procedures, and an Outside the Hospital Do-Not-Resuscitate (DNR) order. The DNR only applies to CPR and doesn’t affect anything else. A DPOA ensures that all options will be considered in any given health care-related situation and decisions will be made in accordance with the patient’s wishes and church teaching.
Under state law, you may specify a particular individual — a family member or close friend — as your health care surrogate, a Durable Power of Attorney for Health Care. A DPOA is empowered to make decisions on your behalf when you are no longer able to, and unless stated otherwise in the document, a DPOA can make all decisions that you could make while competent, including decisions on life-sustaining treatments.
When choosing the person you want to serve as your DPOA, choose someone of good moral character, who knows you well, is familiar with your religious beliefs, can understand medical information, operates well under stress, and who will be sure that end-of-life decisions on your behalf will be consistent with your wishes and church teaching.
The MCC suggests having a talk with the person you select as your DPOA about your preferences while you are healthy and competent, and have talks with them periodically. Your DPOA will be interpreting your wishes as medical circumstances change and could be called upon to make decisions you might not have foreseen.
Under Missouri law, you are also allowed to make a written Declaration concerning your future health care, specifically what care you should receive in the event of imminent death. This type of advance directive allows you to state your intention to allow your physician to withhold or withdraw medical procedures that would only prolong the dying process. The Declaration differs from a DPOA in that your wishes are expressed in writing, not through a surrogate. The Declaration would speak for you.
While the Declaration is legally viable in Missouri, the DPOA is more versatile. In the DPOA document, you can express your intentions, outline the medical treatments you wish to receive in the event of imminent death, and allow your surrogate to speak for you on health care decisions when you are no longer able to do so.
The DPOA statute does not permit you to choose your physician or an employee of your physician as your health care surrogate.
The document becomes effective upon your incapacitation, determined by an examination by two physicians. Before that time and later, if you should regain the power to do so, you have the right to make your own health care decisions.
The DPOA document does not expire, but you may update or change it at any time by simply completing and dating a new one. You will need two adults and a notary public to sign the document and witness your signature. Keep a copy of the document and give copies to your physician, your named surrogate and your alternate surrogate, in the event your named surrogate cannot serve.
The Missouri Catholic Conference and the diocesan Respect Life Office suggest the best time to create a Durable Power of Attorney for Health Care directive is before you enter a hospital or nursing home, or become seriously ill.
For more information, visit www.respectlifemissouri.org → Resources → End of Life Issues → A Catholic Guide to End of Life Decisions for Individuals and Families. There you can find detailed information about the new Missouri Catholic Conference document and a printable draft of a Durable Power of Attorney-Health Care document.
You can also contact Bill Francis, director, Respect Life Office, (816) 756-1850, ext. 544 or email firstname.lastname@example.org.