There are documents floating about these days known as “living wills.” The name is peculiar because a will deals with the distribution of property after death, but these “wills” give directions to physicians about the provision of health care for those who are still living.
They often begin “If I should ever become unconscious or incompetent to make medical decision on my own behalf, I hereby give my physician permission ...” and proceed to list various procedures that may or may not be employed on their behalf.
Advocates of euthanasia have been promoters of living wills. They see the use of such documents as moving the nation closer toward the goal of giving health care personnel the freedom to kill patients who request death.
Catholic teaching does not oblige us, however, to keep ourselves alive for as long as possible or at all costs. There are times when it is best to allow nature to take its course. When nothing more can be done to extend a person's life without imposing undue burdens, then we provide “comfort care” for that individual until he dies.
One may put into writing his wishes about the type of care and treatment he would like to receive at the end of life. No one may ask to be put to death at the hands of his loved ones or his physician, but instructions to refuse treatment that is excessively burdensome or futile may prove helpful to family and friends who are obliged to assume responsibility for a loved one no longer able to make his wishes clear.
The Church was initially reluctant to recognize even the legitimate use of the living will — there are some good reasons not to have one. First of all, the Church did not want to appear to be giving any support to the advocates of euthanasia. We cannot even appear to give aid and comfort to the “culture of death,” as the Holy Father has so aptly termed it.
Second, it is hard to know what sort of circumstances will arise when we are dying. To try to anticipate and give instructions about all medical eventualities ahead of time is virtually impossible.
In the worst scenario, a family may find itself in possession of a living will that gives instructions that are contrary to the best interests of a loved one. Will the attending physician feel obliged to follow through on the requested course of action even though it might cause the patient more pain and suffering, conflict with the wishes of loved ones, or hasten death? A living will can greatly limit the freedom of a physician to respond to the patient's needs in changing circumstances.
Other doctors, however, like the idea of having a piece of paper that makes clear what sort of treatment the patient would or would not want if he were unconscious and dying. It may be that the likelihood of a lawsuit is lessened because the patient has clearly expressed his wishes in writing about a particular course of action. It is sad that legal considerations must sometimes take precedence over the best interests of the patient.
Possession of a living will, on occasion, gives the physician a strong tool for resolving disputes among family members about the kind of medical care their loved one should receive at the end of life. At other times, however, family members produce dueling living wills or encourage an aged relative to sign a new living will that thwarts the wishes of others.
The Church did cease its opposition to living wills when the push for their acceptance proved overwhelming. As states began granting legal standing to the documents, Catholic authors went to great lengths to draw up “Catholic Living Wills” that would provide for the withdrawal of extraordinary means of preserving life without giving any approval to the direct killing of another.
In 1990, Congress passed the Patient Self-Determination Act, which obliged hospitals and nursing homes to inform incoming patients of their right to have a living will on file. Unfortunately, some hospitals and nursing homes then began telling their patients that the law mandates the possession of a living will. That is not true. Nor is an incoming patient obliged to fill out the living will that he is handed upon admittance. Indeed, some of these documents do not conform to Catholic moral teaching.
Many state Catholic conferences, dioceses, Catholic hospitals and nursing homes have drawn up their own versions of a living will. These vary in quality and the Catholic would be well advised to make sure that the document he signs both conforms to Catholic moral teaching and to the laws of his state. The National Catholic Bioethics Center has produced a document valid in the state of Massachusetts and some other states, referred to as an “Advance Medical Directive” rather than a living will.
We want to avoid any association with the euthanasia movement and, quite frankly, the title more accurately states what the document does. More importantly, on the reverse side there is a form to assign durable power of attorney for health care. This enables one to indicate who will assume responsibility for making health care decisions if someone is unable to do so himself. Designating durable power of attorney overcomes most of the difficulties associated with a living will, because it assigns the responsibility for end-of-life decisions to a living person who knows you well enough to represent your best interests in the changing circumstances that may surround the time of your dying.
Dr. John Haas is president of the National Catholic Bioethics Center in Boston, Massachusetts.