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| Death: Our Birth into Eternal life
Fr. Joseph Baker |
The following article is the next installment in a series that will appear in the Catholic Herald to offer catechesis and formation concerning end-of-life decisions, dying, death, funerals, and burial of the dead from the Catholic perspective.
We should all be prepared for those difficult situations when end-of-life medical decisions need to be made.
Modern medical advancements have given us wonderful opportunities to bring about cures, to slow the progression of diseases, and to alleviate many symptoms.
These same advancements, however, sometimes create difficult decisions when treatment would only secure a precarious and burdensome prolongation of life.
Decisions become even more difficult when a person has not expressed their wishes about the use of particular treatments and is no longer able to express their wishes on their own.
Some important questions we all must ask ourselves are: Who do I want to be making decisions about my treatment if I am unable to do so? How can I make sure the decisions made about my health care are morally right? Who will speak for me if I cannot speak for myself?
People often ignore or avoid questions like these until faced with a difficult decision.
Many of us believe that only the sick or dying need to think about such matters, however, these are questions we all must ask ourselves and be able to answer.
There could come a time in our life when we cannot communicate our wishes.
Advanced health care planning
Without advanced health care planning, a “health care surrogate” (HCS) will be appointed by the doctor or nurse if the doctor determines that you are unable to make medical decisions yourself.
Once it is determined that you no longer have capacity, you no longer have control over your decisions.
The person with decision-making power can withdraw, withhold, or request life-sustaining or life-saving treatments.
While a surrogate must act in your best interest, they may disregard your wishes or other considerations.
To avoid this scenario, advanced health care planning is an imperative and positive thing to do.
Advance health care directives are legal documents that take effect when a person becomes incapacitated and unable to make medical decisions on their own.
There are the various forms such directives can take — namely, a Declaration to Physicians, also known as a “living will”; Physician Orders for Life-Sustaining Treatment, known also by the acronym POLST; an Emergency Care “Do Not Resuscitate” Order, known also by the acronym DNR; and Power of Attorney for Health Care, known also by the shortened acronym POA.
It is important to be aware of the different directives that are available, because, depending on how they are crafted, some can be counter to Catholic morality and more harmful than we might realize.
A ‘living will’
A Declaration to Physicians, or “living will”, makes it possible for individuals to state their preferences for life-sustaining procedures and feeding tubes in the event that an individual is in a terminal condition or persistent vegetative state.
The withholding or withdrawal of any medication, life-sustaining procedure, or feeding tube may not be made if the attending physician, physician assistant, or registered nurse advises that doing so will cause pain or reduce comfort, and the pain or discomfort cannot be alleviated through pain relief measures.
There are several weaknesses and disadvantages to using this form of advance health care directive: Living wills are not real-time decisions; they attempt to write instructions for an unknown future condition with unknown medical treatments and other unknown factors; they can be filled out without consultation or communication with a medical professional; and they are very limited in scope — i.e., they are limited to the particular cases of terminal illness or persistent vegetative state.
Because better alternatives exist, Catholics are discouraged from using living wills.
Physician Orders for Life-Sustaining Treatment
A Physician Orders for Life-Sustaining Treatment (POLST) is similar to a living will in content, although it is filled out in consultation with and signed by a medical doctor.
It is also different from a living will, which is merely a directive, whereas a POLST is a medical order.
The Wisconsin Catholic Conference (WCC), in their document Upholding the Dignity of Human Life, has identified several significant concerns with the use of POLSTs: POLSTs do not need to be signed by the patient, raising concerns whether it truly represents the patient’s choices; POLSTs oversimplify decisions about life-sustaining medical treatment and the use of medically administered nutrition and hydration; and POLSTs treat all options as if they are morally neutral.
For these reasons, the bishops of Wisconsin ultimately conclude that the use of POLSTs presents a serious and real threat to the dignity of human life.
Therefore, because of its deficiencies, Catholics should avoid using POLSTs.
Emergency Care ‘Do Not Resuscitate’ Order
A very common advanced directive is an Emergency Care “Do Not Resuscitate” Order (DNR).
It is important to understand the limited scope of a DNR.
When a DNR is in place, a health care provider may still clear one’s airway, administer oxygen, position a person for comfort, splint an injury, control bleeding, provide pain management, and provide emotional support.
A DNR only precludes a health care provider from performing chest compressions, inserting advanced airways, administering cardiac resuscitation drugs, providing ventilator assistance, or using a deliberator.
As discussed in the article on forgoing the use of life-sustaining treatment, individuals are not obliged to use a treatment that does not offer a reasonable hope of proportionate benefit or if there is a physical or moral impossibility in the utilization of a particular treatment.
With this in mind, some factors worth considering are: the risk of rib or other bone fractures; the possible puncture of the lungs by a broken bone or from the trauma of lung compression/decompression; the bleeding that can occur in the center of the chest; potential cerebral dysfunction or permanent brain damage; the risk that the patient might end up entering a vegetative state; and subsequent complications following resuscitation.
Especially for older patients, the benefits of resuscitation are often few and short-lived, while the burdens tend to be high.
Putting a DNR in place is morally permissible when the determination is made that resuscitation no longer offers a hope of proportionate benefit, or that it entails a physical or moral impossibility.
Indeed, in some situations, having a DNR in place is an appropriate rejection of therapeutic obstinacy, not prolonging a person’s life at all costs, but allowing them to die peacefully.
Nevertheless, it must be noted that a DNR cannot be required as a condition for admittance into a healthcare facility.
Power of Attorney for Health Care
The last form of advance health care directive is Power of Attorney for Health Care (POA), which will be addressed in the next article.
As one might guess, POAs are the best form of advance directive, allowing for real-time decisions to be made following Catholic values and principles.
Even if you already have a living will or POLST in place, individuals retain the right to change their advance directives at any time.
Thinking about what kind of medical decisions you would want to be made if you were unable to communicate or decide for yourself is not easy. It takes thought, discussion, and prayer.
O God, protector of all who hope in you, bless your people, keep them safe, defend them, prepare them, that, free from sin and safe from the enemy, they may persevere always in your love. Through Christ our Lord. Amen
Fr. Joseph Baker is the ethicist for the Diocese of Madison and the pastor of Blessed Trinity Parish in Dane and Lodi.