Advanced Planning for Healthcare

Modern medicine and medical technology have made it possible to extend the length of life as well as the quality of life. Along with these advances, however, have come concerns. Patients question whether medical technology will keep them alive needlessly. Will they become prisoners of machines? Families and loved ones of an incompetent patient agonize over critical health care decisions. It also is difficult sometimes to determine which family member(s) should make decisions for incapacitated people. At other times physicians are reluctant to remove life support unless clearly protected from liability. These concerns and a variety of court decisions have highlighted the need for a person to provide advance directives and thus ensure that death occurs for each person in a morally acceptable manner.

There are three principles that should be considered: a) Human life is a gift from God. Because human life is a sacred gift we must protect it as would any good steward. We have an obligation to take normal means to preserve and protect life. b) Death is a beginning, not an end. As believers in the mystery of the Resurrection, we know our current life is not all there is. We need not do everything possible to prolong our life. c) We have the right to direct our own care. Each person has two rights regarding medical care and treatment: the right to be clearly and accurately informed about a proposed course of treatment and its consequences, and the right to decide to receive or not receive treatment in accord with the moral law.

Yes. My moral commitment to pursue, preserve and protect my life exists even when I am incompetent. I have the right to ask another, who is to be motivated by authentic love of neighbor, to seek my best interests and to make my health care decisions when I am no longer able to do so.

Yes. We know that authentic love of God is expressed in loving concern for others. The obligation to love one’s neighbor requires that those who are healthy care for the person who is incapacitated within proper moral parameters. The solidarity of interdependence of the human family is the ethical basis for proxy decision making.

First priority should be given to a person who has personal knowledge of you and shares your value system. As a minimum, there should not be any conflict of interest between you and your surrogate.

From an ethical perspective you are capable of making your own health care decisions when you are able to understand and appreciate the nature and consequences of your illness, the treatment alternatives that are available and the consequences of your choices in light of the values you hold.

Yes, the same limits that apply to you. Because we are stewards of life, neither you nor your surrogate can intentionally commit or omit actions which by their nature or their consequences would directly cause your death.

There should be three stages to the surrogate’s decision making process: a) If you have clearly stated your intentions in an explicit manner and the circumstances are appropriate, then those wishes should be followed by the surrogate. b) If it is possible to conclude from your expressed values and previous life decisions how you would decide in this specific situation, that is how the surrogate should act. c) In the absence of the above, then the surrogate should act in your “best interests.”

The concept of “best interests” is complex related to stages b) and c) mentioned in number 8. From an ethical perspective there are several components to a person’s “best interests.” One must consider what is beneficial for you. Your preferences, insofar as they are known, are relevant. So, too, is an understanding of that which constitutes the basic goods of being human. Finally, your fundamental values and beliefs must be considered. Because of this complexity, it is obvious that what might be in the “best interests” of one person might not be in the “best interests” of another. For this reason it is important that at the very least you make your wishes and intentions known, and at the best, appoint a surrogate you believe will decide in your best interests.

One begins by studying the type of care or treatment to be used; “its degree of complexity or risk, its costs and the possibilities of using it, and comparing these elements with the result that can be expected, taking into account the state of the sick person and his or her moral resources.”* In this context one then determines whether this particular form of care or treatment will achieve its purpose and/or is not unduly burdensome. If the care or treatment is useless (will not achieve its purpose) and/or is unduly burdensome, then it is not morally required.

Since food and water are necessities of life for all human beings and can generally be provided without the risks and burdens of more aggressive means of sustaining life, there should be a strong presumption in favor of their use. Because of the complex nature of medical realities in these matters and the obligation to protect the rights of the handicapped, the medically incompetent, and other helpless patients, great caution and serious attention should be paid to all reasons or motives involved in withdrawing or not initiating artificially provided nutrition and hydration (intravenous feeding, tube feeding, etc.) That being said, it is possible, on a case by case basis, for you or your surrogate, utilizing the principles outlined in #10, to determine that artificially provided nutrition and hydration are not morally required. In such instances, however, all other normal patient care due to a sick person must be provided (e.g., comfort, hygiene, freedom from pain, etc.). Finally, the reason or intention for making such a decision must not be to directly bring on death, but must be to spare the patient care or treatment that is not morally required.

No! One determines whether euthanasia or suicide is present by examining the intention and the methods used. When the intention and methods are in accord with the principles outlined in #10 and #11, then you or your surrogate are acting in a morally proper way. You are accepting the human condition or avoiding useless or unduly burdensome care or treatment.

The following paragraph reflects the ethical guidance given above. In fact, you might wish to include this paragraph in any written advance directive you may have (such as a Durable Power of Attorney for Health Care):

As regards to life sustaining treatment, I declare my belief that life is a sacred gift from God.

However, it is not the highest value.

“Accepting death is a sign of our recognition of the human condition.”

Therefore, I do not want my life prolonged, nor do I want life sustaining treatment to be provided, including artificial nutrition and hydration, if the burdens of the treatment outweigh the benefits or if the treatment would be ineffective. In this regard, I want my agent to consider the relief of suffering, the expense involved and the burdensome conditions of the treatment(s) associated with the extension of my life in making decisions as regards the initiating, withdrawing and/or life sustaining treatment.

* from Declaration on Euthanasia, Congregation for the Doctrine of the Faith – May 5, 1980