Letting your wishes be known with advance directives and the like

By Marty Denzer
Catholic Key Reporter

KANSAS CITY — If you’ve been admitted to a hospital in recent years, you probably were asked umpteen times, “Do you have a Living Will?” And, if you said no, there may have been some pressure to fill one out. Living Wills, advance directives and similar forms are intended to inform physicians and hospital staff of a patient’s preferences regarding certain procedures and treatments, especially as the end of life nears. However, be aware that they don’t always do what they are intended to do.

It isn’t always possible to bring legal documents to a hospital, obviously. People suffer strokes or heart attacks, accidents occur and, in the rush for medical care, documents are not the first things thought of. It might not be a bad idea to make copies of the durable power of attorney for health and of advance directives, give a copy to your chosen agent, leave a copy with your lawyer and keep a copy in your wallet or purse. That way, your wishes will be known and not ignored, especially if you can voice them. Closer attention will be paid to your agent, if he/she has copies of the documents in hand and can keep cool and collected under pressure from health care providers, friends and family members.

Local family physician Austin Welsh, a geriatrician, member of the Catholic Medical Association and a Knight of Malta, said that in mapping your advance directives, the cardinal virtue is prudence. Keep in mind that interpretations of your wishes might vary with different care providers and family members. Dr. Welsh mentioned that some people say they would prefer any and all treatments or procedures that might prolong life, no matter the benefit percentage or the cost to themselves, family or community. As Catholics, he said, we have an obligation to act as responsible stewards of life, finances and of our families. Physical and financial burdens must be considered before saying, “Yes, I want that procedure or this treatment.”

One of the principles of advance directives is autonomy, Dr. Welsh said. With written advance directives, a patient and his/her agent can make independent decisions, following the guidelines of Catholic Church teaching, for themselves or for the patient. But, it is important to be aware that “advance directives can set rules for games you might never play,” he said. For example, feeding tubes can be tricky. Even if a patient has an advance directive to not have a feeding tube, it is ethically difficult to stop them, Dr. Welsh said. Nutrition and hydration, whether given orally or medically assisted, are necessary for life. And there are circumstances where refusing medically assisted nutrition and hydration could be tantamount to suicide, which the Catholic Church considers morally wrong. So what can you do?

First, give some thought to your choice of agent and your wishes and advance directives. Read up on treatments or procedures of interest to know more about benefits, risks, side effects and costs before selecting or refusing them. You might also talk to your parish priest.
Bill Francis, director of the diocesan office Respect Life Office, recommended not waiting until the last minute or trying to select an agent and list your wishes under stressful times.

“The most important thing,” he said, “is having someone who knows you and what you want and don’t want, to speak on your behalf. That is more important than a document.” He cautions that “living wills can be suspect because you can’t always guess right on medical and financial circumstances in the future. They are not intrinsically evil, but since they are often based on a snapshot [of emotions, circumstances and health] taken one, two or even five years in the past, they are risky since all the moons have to line up and they very rarely do.” The role of your agent takes on greater importance in the decision making process concerning your health and well-being.

Catholic hospitals, nursing facilities and hospice adhere to the Ethical and Religious Directives published in 2009 by the U.S. Bishop’s Conference, and so will not honor advance directives that are contrary to Catholic teaching, for instance euthanasia and assisted suicide. An explanation of why a directive was not honored is to be provided.

The person chosen as your agent should be faithful to the Catholic moral principles, and to your intentions and values, the ERD’s state. And if your intentions are not known, he/she should be faithful to your best interests. If there are no advance directives, those who are in a position to know what you would prefer or refuse, usually family members and loved ones, should participate in the health care decision-making process.
The ERD’s go on to state that the” free and informed consent” of a patient or the patient’s surrogate “is required for medical treatments and procedures, except in an emergency situation when consent cannot be obtained and there is no indication that the patient would refuse consent.” The free and informed consent requires the patient or the surrogate “receive all reasonable information about the essential nature of the proposed treatment and its benefits, risks, side effects, consequences and cost, and any reasonable and morally legitimate alternatives, including no treatment at all.” The greater the patient’s incompetency and vulnerability, the greater the need to justify treatments, procedures and therapeutic measures, according to Catholic teaching.

Dr. Welsh reminded that Catholics should not fear death, as it opens the doorway to heaven, so a patient or their agent should make sure the last sacraments are available if death nears. The Sacrament of the Sick is also beneficial emotionally and has been known to benefit a patient’s health. Catholic teaching states we are also called to be good stewards of our health and well-being, and have a duty to preserve life and use it for the glory of God. That duty is not absolute however, for life-prolonging procedures that are insufficiently beneficial or excessively burdensome physically or financially may be rejected by a patient or their chosen agent. Every case is unique and should be treated as such.
Bill Francis agreed, saying “the goal is not to avoid death at all costs. Catholic teaching makes sense. Suffering can be redemptive, especially if it is mapped to Christ’s suffering on the cross.”

The Catechism of the Catholic Church (1501 and 1505) says that accepting the suffering that comes with illness, old age and the dying process can “make a person more mature helping him discern in his life what is not essential so that he can turn toward that which is. Very often illness provokes a search for God and a return to him … By his passion and death on the cross, Christ has given a new meaning to suffering: it can henceforth configure us to him and unite us with his redemptive Passion.”

Pope Francis, in his Message for the 2016 World Day of Sick, wrote that faith in God might be tested and some people might fall into despair or be angered, but “illness can also deepen faith. Not because faith makes illness, pain or the questions they raise disappear, but because it offers a key by which we can discover the deepest meaning of what we are experiencing; a key that helps to see how illness can be the way to draw nearer to Jesus, who walks by our side, weighed down by the cross. Mary offers us that key, the pope explained, because she has experienced this path herself, firsthand. Jesus comes to those in need, offering his mercy and healing.” Mary also provides comfort and “we see reflected the tenderness of God” in her concern for her children. “This same tenderness is present in the lives all those who attend the sick and understand their needs, even the most imperceptible ones, because they look upon them with eyes full of love.” It follows that healthcare agents feel similar tenderness. (Message released Sept. 15, 2015)

Yes, we all want to live full, happy and useful lives, consistent with our Catholic faith, but it never hurts to plan ahead, if, to use Bill Francis’ image, the moons in your life get out of sync.


October 24, 2016
Newspaper of the Diocese of Kansas City ~ St. Joseph