Advance care planning is a positive thing to do. The most essential thing any one person can do is to speak to your family, your loved ones, your doctors, and trusted clergy members regarding the hour of your death. Make sure they know your desire to be faithful to the teachings of the Church. As difficult as talking about death may be, we should be having these conversations while we are young and healthy in order to most effectively plan for the time when we are not.
The United States Conference of Catholic Bishops urges Catholics to consider designating a proxy decision-maker to make health care decisions for them should they become incapacitated and unable to decide for themselves. They urge the use of advance directives to appoint a health care agent who understands and shares Catholic values, and can help to apply them to the medical situation at hand.
Their specific advice is available here:
“Advance Medical Directives: Planning for Your Future”
Advance Directives are legal documents that take effect when a person becomes incapacitated and unable to make medical decisions on their own. Here are the various forms such directives can take.
Power of Attorney for Healthcare
This document allows you to appoint someone as your health care agent who will have the legal right to make health care decisions for you when you become unable to make them for yourself. When you sign this document, you appoint a person to serve as your spokesperson. That is why it is so important to have conversations with that person, and make your wishes known, prior to when illness or crises strike.
The Health Care Proxy
The health care proxy is very similar to the power of attorney for health care, and is available in many states. It, too, allows you to appoint someone to make health decisions for you should you become unable to make them for yourself. This can be a morally appropriate and useful tool, particularly if you have taken the time to discuss your beliefs, values and wishes prior to the hour of your death. A health care agent can make decisions based on what you have shared, taking into account the current circumstances surrounding your medical condition and available treatment options.
The Living Will
A living will is a written document that allows you to spell out in advance what types of medical treatments you would like to receive or forgo if you had a particular medical condition and became unable to make your wishes known. While most states recognize living wills as evidence of a patient’s wishes, they are the most inflexible of the advance directives, because they attempt to write detailed instructions for a future unknown condition with unknown medical treatments and other unknown factors. No one could possibly predict in advance all of the decisions that must be made in a time of medical crisis. Designating a person to make decisions for you (in a power of attorney for health care or health care proxy) when you become incapacitated is the preferred advance directive. A written living will might be a helpful additional tool to help your appointed health care agent to interpret your wishes at the time decisions must be made.
DNR (“Do Not Resuscitate”)
A DNR order is a medical order that instructs medical personnel not to attempt cardio-pulmonary resuscitation (CPR) if a patient’s heartbeat or breathing stops. It does not affect any other treatment. For Catholics, deciding about a DNR requires weighing benefits and burdens to determine if CPR would constitute ordinary or extraordinary care.
POLST (“Physician Orders for Life-Sustaining Treatment”)
A number of states now recognize POLST (or MOLST “Medical Order for Life-Sustaining Treatment”, sometimes called POST or MOST), which are pre-set forms establishing medical orders to administer or withhold treatments. The orders take effect immediately upon signing; they are not conditioned on the patient losing capacity. They allow patients to forgo anything from antibiotics to medically-assisted nutrition and hydration. Some Church authorities have determined these documents to be intrinsically flawed because they are premised on absolute patient autonomy and they do not allow for truly informed consent. Other Bishops’ conferences have urged caution when deciding to complete a POLST order, as it is intended for use by those who are in the final stages of illness or frailty. POLST has been approached differently in the states due to variance in state laws and interplay with other end-of-life policies. Please check the State Resources section of this website to learn more about specific guidance in your state.