Advance medical directive: A legal document through which an individual may designate a specific person to make health care decisions for them should they become incapable of making decisions, and which may declare the health care treatments they would desire should incapacitation occur. Advance medical directives vary from state to state, but can be used as a way for Catholics to ensure that end-of-life treatment decisions made on their behalf are consistent with the moral teachings of the Church.
Assisted suicide: The voluntary termination of a person’s own life assisted by another, for example, the ingestion of physician-prescribed medications that will cause death. It is the direct and intentional taking of human life, and is always gravely immoral.
DNR: A “do not resuscitate” order is signed by a physician and instructs health care providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s heartbeat or breathing stops. An adult patient, or their surrogate, must consent to a DNR order. For Catholics, deciding about DNR involves weighing the burdens and benefits of CPR in each specific situation, determining if it is ordinary or extraordinary treatment.
Double effect: A moral principle that provides guidance when an action or omission will have two consequences, one of which is moral and intended, and the other is evil and not intended, even though foreseen. For example, medications intended to alleviate pain that have the foreseen but unintended consequence of hastening death may be morally permissible if the benefit is proportional.
Euthanasia: Sometimes called “mercy killing,” euthanasia is the deliberate and morally unacceptable killing of a human person and is always gravely immoral (The Gospel of Life). An example of euthanasia would be the injection of a drug that causes a patient to stop breathing, with the intention that they die in that manner.
Extraordinary (disproportionate) means: Medical treatments that do not offer a reasonable hope of benefit or entail excessive burdens, including medical, financial, personal, familial and social burdens. Extraordinary treatments are morally optional because one is not required to do everything possible to preserve one’s life, and when the burdens and consequences are out of proportion to the beneficial results anticipated, one may decline the treatment. (Ethical and Religious Directives for Catholic Health Care)
Hospice care: A service promoting compassionate care for the dying by providing physical, spiritual and emotional resources for terminally-ill patients and their families. Hospice services may be provided in a home setting or in an institutional setting. The mission of hospice is to celebrate life in the face of death by offering medical, emotional, and spiritual support to the dying patient and their loved ones. Hospice care includes palliative care.
Informed consent: a decision freely made in the full possession of one’s mental faculties and with adequate knowledge of all relevant medical and moral consequences. The free and informed consent of the patient or the patient’s surrogate is required for medical treatments and procedures except in emergency situations where consent cannot be obtained and there is no indication the patient would refuse consent.
Living will: One form of advance medical directive, this document enables individuals to establish what forms of treatment they would want to receive or forgo if in a stated medical condition, such as a persistent vegetative state or terminal illness, and unable to make their wishes known to the health care professionals providing care. It is an inflexible end-of-life planning document because it cannot predict all the possible medical circumstances and treatment options in future situations.
Ordinary (proportionate) means: Medical treatments which offer a reasonable hope of benefit without entailing excessive burdens on the patient or others. Ordinary treatments are morally obligatory; they are considered “proportionate” to the benefits expected. For example, the benefits of insulin for an otherwise healthy person who needs it for diabetes, and who lives in the United States where it is inexpensive and convenient to obtain, are so great compared with the burdens of daily injections, that it should, barring unforeseen unusual circumstances, be considered a moral obligation.
Palliative care: Focuses on providing patients with relief from pain, suffering, symptoms and stress of serious illness. It is sometimes referred to as “comfort care” provided by a team of professionals.
POLST (Physician Order for Life-Sustaining Treatment): A medical order available in some states that involves a series of check boxes for patients (or their surrogates) to outline which treatments they do or do not wish to receive, such as “do not resuscitate” and “do not intubate” orders. The order (also known as MOLST, MOST and POST) must be followed by all medical providers and emergency responders. The POLST paradigm was created for use by those in the final stages of illness or frailty, but is now promoted for a broader array of patients. Caution is urged if completing a POLST form, as it is effective immediately and may unduly tie the hands of health care professionals, since medical circumstances cannot always be perfectly predicted. In every case, the specific condition of the patient should be the starting point of assessing burdens and benefits of treatments, and attention must be given to the sanctity of human life. 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.
Power of attorney for health care (sometimes called “health care proxy”): One form of advance medical directive, this document allows individuals to designate a specific person to make health care decisions on their behalf should they become incapable of making their own decisions. The designated person may be referred to as the “agent,” the “surrogate” or the “proxy.” Most Catholic experts view this advance planning tool to be the safest option because individuals can designate a surrogate who understands and shares Catholic values and beliefs, and can respond to the actual medical circumstances of the patient.
“Right-to-die”: A social movement that, contrary to Church teaching, promotes the right of an individual to take his/her own life or receive assistance to end his/her life prematurely. The Church teaches that we are stewards, not owners, of the life God has entrusted to us; it is not ours to dispose of. (Catechism of the Catholic Church, 2280) The leading “right-to-die” advocacy organization is now called “Compassion & Choices,” and was formerly called the Hemlock Society.