The following article was written and submitted to me by pro-life leaders Judie Brown and Julie Grimstad.

Every time you enter a healthcare facility, you will be informed of your “right” to sign some sort of Living Will or POLST form. These documents are types of healthcare advance directives which allegedly enhance a person’s power to refuse or accept medical interventions. They are not as “beneficial” as they may be described to you.

Before signing any healthcare directive, you need to know some facts that could mean the difference between life and death.

Euthanasia advocates formulated the Living Will

The Living Will was suggested at a meeting of the Euthanasia Society of America in the late 1960s. By the mid-1970s, the Society’s educational arm had distributed three quarters of a million copies. Euthanasia advocates publicly admit that the Living Will was instrumental in promoting societal acceptance of euthanasia.[1]

Euthanasia is defined by the Catholic Church as “an act or omission which, of itself or by intention, causes death in order to eliminate suffering.” The Catechism describes euthanasia as “a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator.”[2]

Most Living Wills contain a statement such as: “If I should have a terminal illness and I am unable to make medical decisions, I direct my attending physician to withhold or withdraw medical treatment that prolongs the dying process and is not necessary to my comfort or to alleviate my pain.” On the surface this statement may sound clear. However, it leaves important questions unanswered such as: What is a “terminal illness”? What is “medical treatment”? These and other crucial terms are open to wide interpretation – not by you but by an “attending physician” who most likely will be a stranger to you and may not share your Catholic values. Also, a physician who is unfamiliar with you may not understand your condition and the underlying problem. For example, a patient who was deaf and nearly blind was not responding to a doctor’s questions. As a result, the doctor assumed she was unresponsive.

The POLST form – a uniquely dangerous advance directive

Physician Orders for Life-Sustaining Treatment (POLST) is a form now used extensively throughout the United States. POLST has many different names and acronyms [e.g., Medical Orders for Scope of Treatment (MOST) and Clinician Orders for Life-Sustaining Treatment (COLST)]. These forms differ in wording, but all of them can be used to encourage refusal of lifesaving and life-preserving treatment and care, resulting in avoidable deaths. Once signed by a designated health care provider, this unusual advance directive becomes medical orders that can go into effect even when a patient is capable of making his or her own medical decisions and/or does not have a terminal condition.

As a routine part of a visit to the doctor, Medicare started paying for conversations about “advance care planning” in January 2016. The goal is to get patients to fill out advance directives (usually POLST forms) limiting treatment.[3]

Recognizing the threat to life that POLST forms pose, the Catholic Bishops of Minnesota “discourage the use of POLST by Catholics and Catholic health care providers.”[4] Wisconsin’s Bishops issued an even stronger warning: “Due to the serious and real threats to the dignity of human life that POLST and all similar documents present, we encourage all Catholics to avoid using all such documents, programs, and materials.”[5]

It is our hope that other states’ Catholic Bishops will follow suit in this grave matter.

The wisest choice: a pro-life Medical Power of Attorney

It is necessary, especially in the present environment of health care cost-cutting and discriminatory “quality-of-life” judgments, to take measures to protect yourself from euthanasia. Information about pro-life advance directives for healthcare is available from American Life League and the Healthcare Advocacy and Leadership Organization. (Contact information is provided below.)

In most cases, a pro-life Durable Power of Attorney for Health Care (DPAHC) is the best advance directive a person can choose. A DPAHC is a legal document in which you appoint a trusted family member or friend to be your “agent” (called a “proxy” or “surrogate” in some state advance directive laws). Your agent will make medical decisions for you in the moment of need if you are unable, either temporarily or permanently, to do so for yourself. We encourage all persons aged 18 or older to complete a pro-life DPAHC.

It is crucially important to choose as your agent a person who will make decisions based on your wishes and Catholic teaching.

When is it morally permissible to withhold or withdraw medical treatment?

The Catechism of the Catholic Church answers this question quite succinctly:

Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of "over-zealous" treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.[6]

The following are basic Catholic principles for medical decision-making.

1. No matter what life-sustaining procedure/medical treatment is in question, when in doubt, err on the side of life. A medical intervention can be tried with the option of stopping it if it proves ineffective or excessively burdensome for the patient.

2. It is the physician’s obligation to truthfully and fully, in layperson’s terms, discuss with the patient or patient’s legal representative the benefits, risks, cost, etc. of available medical means that may improve the patient’s condition or prolong life. The focus should be on what the medical decision-maker needs to know to give informed consent or refusal for treatment.

3. The patient or the patient’s legal representative makes the decision whether a treatment itself is too burdensome, extraordinary, etc. If the patient wishes to fight for every moment of life, this is a legitimate interest to be respected when possible.

4. It is impossible to make morally sound, sensible, informed healthcare decisions based on guesswork about a future illness or injury and treatment options. Healthcare decisions must be based on current information.

5. Two extremes are to be avoided:

   • Insistence on physiologically useless or excessively burdensome treatment even when a patient may legitimately wish to forgo it.

   • Withdrawal or withholding of treatment with the intention to hasten/cause death. This is euthanasia by omission.

6. The object and motive for administering pain medication must be to relieve pain; death must not be sought or intended.[7]

7. Nutrition and hydration, whether a person is fed with a spoon or through a tube, is basic care, not medical treatment. Insertion or surgical implantation of a feeding tube takes medical expertise, but it is an ordinary life-preserving procedure for a person who has a working digestive system but is unable to eat by mouth. Circumstances and intent determine the morality of withholding food and fluids.

   • Acceptable – During the natural dying process, when a person’s organs are shutting down and the body can no longer assimilate food and water or their administration causes serious complications, withdrawing food and fluids is both medically and morally appropriate. In these circumstances, the cause of death is the person’s disease or injury, not deliberate dehydration and starvation. This is not euthanasia.

   • Unacceptable – When a person is not dying—or not dying quickly enough to suit someone—food and fluids often are withheld with the intent to cause death because the person is viewed as having an unacceptably low quality of life and/or as imposing burdens on others. The direct cause of death will be intentional dehydration and starvation, not the person’s disease or injury. This is euthanasia.

We advise you to discuss these principles and share your wishes for end-of-life care with your physician, family members, and a spiritual advisor, and especially with your agent—the person who will speak on your behalf if you are unable to do so. Feel free to contact us with any questions you may have about advance directives for healthcare or medical decision-making.

Contact information:

American Life League (ALL): https://www.all.org; resources@all.org

Healthcare Advocacy and Leadership Organization (HALO): https://www.halovoice.org; feedback@halovoice.org

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About the Authors:

Judie Brown: wife of dearly departed Paul Brown, mother of three, grandmother of 13; co-founder of American Life League Inc. 1979; advocate for respect for every person, born and preborn.

Julie Grimstad: wife of William Grimstad, mother of five, grandmother of 12, great-grandmother of four; co-founder of the Healthcare Advocacy and Leadership Organization (HALO), immediate past president and current member of HALO’s Board of Directors; writer, speaker, and advocate for the medically vulnerable.

References

[1] See “History of Euthanasia in U.S.: Concept for Our Time,” Euthanasia News, Vol. 1(4), November 1975 (publication of the Euthanasia Educational Council [educational arm of the Euthanasia Society of America]), pg. 3.

[2] Catechism of the Catholic Church, no. 2277.

[3] “The Dangerous POLST Form,” https://halovoice.org/advance-directives-for-healthcare-part-two/

[4] A Pastoral Statement on Physician Orders for Life-Sustaining Treatment (POLST), Minnesota Catholic Conference, January 31, 2013, https://www.mncatholic.org/stewards-of-the-gift-of-life/

[5] Upholding the Dignity of Human Life, A Pastoral Statement on Physician Orders for Life-Sustaining Treatment (POLST) from the Catholic Bishops of Wisconsin, July 2012, http://www.gbdioc.org/images/stories/News_Events/pdf/WCC-POLST-Statement_07-12-2012.pdf

[6] Catechism of the Catholic Church, no. 2278.

[7] Catechism of the Catholic Church, no. 2279.