Most of us are able to make decisions and talk with our doctor directly about the medical care we desire. But what if you are unable to speak for yourself or think rationally, as can happen with a serious injury, illness, or at the end of your life? Fortunately, you can still make your health care wishes known by preparing an Advance Health Care Directive today (also called an Advance Directive).

An Advance Health Care Directive is a document that covers two important matters:

It makes known what health care treatments you do or do not want if you have an accident or become seriously ill.
It designates another person to be your agent or representative to make medical decisions for you when you cannot communicate your treatment wishes.

All adults, regardless of age or health, should create an Advance Health Care Directive. It’s never too early to start the conversation about planning for your future health care.

However, as Catholics, navigating the secular healthcare system and its questionable/dubious/lack-of (word choice) ethics is a big challenge. We want to make good decisions about life-sustaining treatments and end-of-life care that always remain true to the teachings of the Catholic Church. We want to remain faithful to the end.

With our experts at My Catholic Doctor, you can start the conversation to plan your future healthcare. You will then have an invaluable document to protect your wishes while honoring your Catholic faith. Let’s work together and get started today!

FAQ's

What is an Advance Health Care Directive?

An Advance Health Care Directive is a document you fill out in advance to express your wishes for health care in the event you become seriously ill or incapacitated. These instructions help inform clinicians and your family about your preferences for medical treatment.

An Advance Directive is used to express your personal or moral values, your religious beliefs, and overall desires for care. It can specify when efforts to prolong your life should be started, stopped, or declined.

They are also used to name another person to make all health care decisions for you in the event you become unresponsive or are unable to communicate. Some causes include traumatic head injury or coma following an accident, a sudden stroke, advanced dementia, or at the end of life.

Advance Directive for Catholics: the Protective Medical Decisions Document

taken from patientsrightscouncil.org

What is the Protective Medical Decisions Document (PMDD)?

“The PMDD is a protective Durable Power of Attorney for Health Care which is available from the Patients Rights Council. It is a document in which you name someone you trust (a family member or a close friend) to make health care decisions for you if you are ever permanently or temporarily unable to make such decisions for yourself.”

What makes a PMDD necessary?

“The following are some of the reasons that a PMDD is necessary:

Federal regulations require every hospital and health program that receives any Medicare or Medicaid funds to inform you, upon admission, of your rights regarding an advance directive. As a result, many facilities are giving patients a Living Will or Durable Power of Attorney to sign at the time of admission — when you’re naturally under stress and you’re filling out other paperwork.
Many hospitals are instituting “futile care” guidelines which may preclude the wishes of a patient who is unable to communicate. The PMDD specifically states that the meanings of “beneficial” and “appropriate” care are to be left to the agent who knows the values and wishes of the signer.
An effort is underway across the country to add euthanasia and assisted suicide to end of life options. The PMDD specifically prohibits euthanasia and assisted suicide.
Previously, family members were automatically considered the decision makers for a loved one. This is rapidly changing. Unless you have named someone as your agent to make decisions for you if you can’t give informed consent, a health care provider or court appointed guardian who doesn’t know your values and wishes may make critical decisions for you.
Ever since the federal Health Insurance Portability and Accountability Act (HIPAA) went into effect, some health care facilities have refused to provide information to anyone – even family members – about a hospitalized adult unless the patient has given written consent. The PMDD gives your agent the authority to obtain necessary information in the event that you are unable to give written consent at the time of hospitalization.”

How does the PMDD differ from a “Living Will”?

“The PMDD is a Durable Power of Attorney for Health Care. A Living Will is a document, often called a “declaration” or a “directive,” in which the signer gives power and authority to an “attending physician” to withhold or withdraw medical interventions under certain circumstances. Because the “attending physician” may be a total stranger who is completely unfamiliar with the signer’s values and wishes, terms in the document may be interpreted by the physician in a manner that was not intended by the signer. Also, with the Living Will, family members and others — who are familiar with the signer’s values and wishes — have no legal standing to interpret the meaning of the directive.”

Are there any limitations on my agent’s authority?

“Yes, the PMDD limits your agent’s authority in one specific way. It makes it clear that your agent does not have the authority to approve the direct and intentional ending of your life.

For example, your agent may not authorize that you be given a lethal injection or an intentional lethal drug overdose. Further, your agent may not direct that you be denied food or fluids for the purpose of causing your death by starvation or dehydration.

This limitation not only protects you but also protects your agent from being subjected to pressure to authorize such actions or omissions.”

Is the PMDD valid in every state?

“The Multi-State version of the PMDD conforms with the laws of most states. Some states, however, have specific statutory requirements for a durable power of attorney for health care. For those states, the PRC distributes PMDDs specifically drafted to meet the state’s technical requirements. Those states include: AK, AL, CA, CT, DE, FL, HI, IN, KY, MD, MI, MN, MO, NC, ND, NE, NH, NV, NY, OH, OK, OR, SC, TX, VT, WV and WI.”

Why do I need an Advance Health Care Directive?

Without an Advance Directive, if you become unable to speak for yourself, someone else may be making critical decisions about your treatment. Do you want your care determined by hospital staff or strangers? Their decisions may not align with yours and may even contradict your wishes or religious beliefs!

That’s why clinicians prefer these Advance Health Care Directives. If a situation arises where important medical decisions must be made, your directive tells them precisely your wishes because you have set it in writing ahead of time.

Consider Advance Directives as a GIFT that gives peace of mind to your family or caregivers by avoiding conflicts or confusion because your desires are clearly stated in writing. This can also give YOU peace of mind knowing you can avoid pain and suffering, lengthy or unhelpful procedures, or unnecessary hospitalization – or, if you so choose, you can have every effort made to prolong your life as far as reasonably possible.

I’m married. Doesn’t my spouse automatically have the right to make health care decisions for me, even without an Advance Directive?

Not necessarily.

DIRECT QUOTE FROM PRC WEBSITE: “[If] a person hasn’t left written directions about health care, all states have laws giving decision-making authority to the person’s spouse. Sounds logical. But it’s not quite accurate.

Forty states and the District of Columbia do, indeed, have laws specifying who can make decisions for a patient who does not have an advance directive. In many — but not all — of those states, a spouse is designated as first in priority, followed by adult children, parents, and siblings. Other states have different procedures for deciding who will speak for a patient.”

(from https://www.patientsrightscouncil.org/site/advance-directive-be-prepared/)

I’m young and healthy. Why do I need an Advance Health Care Directive?

It is absolutely essential that you establish an Advance Health Care Directive

It is impossible for any of us to predict the future. An emergency or personal tragedy can happen to anyone, at any age, at any time. Creating your plan today helps ensure that someone you trust can make the important medical decisions that will reflect your health care wishes in any situation.

Do I need a lawyer to create an Advance Directive?

Most states offer free Advance Health Care Directive forms online. They are generally simple and straightforward to complete. With the guidance and recommendations from My Catholic Doctor providers, most people will be able to complete these forms without the help of a lawyer. Some individuals are more comfortable with utilizing a lawyer, and we support that if you are inclined. We suggest that you do not delay if you do not have a lawyer.

What are the parts of an Advance Directive?

The two basic parts of an advance directive are Health Care Power of Attorney and Living Will.

Health Care Power of Attorney (POA)

This is a written document that you use to appoint another person to speak on your behalf. This person is then called your Health Care Agent, Surrogate, or Proxy and he or she speaks directly to the clinicians to help guide your care. You can designate a family member, friend, or other trusted individual over age 18 to be your agent. This document only becomes effective when your doctor determines you have lost the ability to make your own health care decisions.

Once activated, your agent has full authority to start or stop life-prolonging measures, make decisions about medical and mental health treatment, choose which providers and facilities oversee your care, review and share medical information, and handle matters such as the disposition of your body after death.

You choose one person as your primary agent, and a second person may be added if the first person is unable or unwilling to represent you.

Remember: Without a Health Care Agent to speak for you, critical decisions may be left to the medical staff or hospital!

Living Will

A Living Will is a written document that informs your doctors and loved ones about the type of care you want if you are terminally ill or unconscious. It can be considered a personal “Declaration to Doctors” as well as to your family.

Possible topics covered in a Living Will include terminal or incurable conditions that will result in your death within a short period of time, a state of unconsciousness where a number of doctors are confident you will not regain consciousness, and advanced dementia or other irreversible loss of mental function. This directive only takes effect when there is no realistic hope of recovery.

You can specify your preferences regarding life support and other life-prolonging measures, and wishes for end-of-life care. Life-prolonging treatments attempt to postpone death which include breathing machines (assisted ventilation), kidney dialysis, artificial nutrition and hydration (feeding tubes or IVs), antibiotics, and other similar types of life-sustaining treatment.

A Living Will can also cover surgical treatments, nursing home care and hospitalizations, medical and psychiatric treatment, home health care, and organ donation.

Remember: Without a living will, your medical decisions may be left up to the medical staff! That’s why completing a living will AND choosing a Health Care POA are important parts of your advance directive.

Can I still make my own decisions after I fill out an Advance Health Care Directive?

Yes. Only when you are unable to make decisions for yourself does your Living Will take effect. Your Health Care Agent will also be asked to make medical decisions on your behalf.

Also, a Living Will and Health Care Power of Attorney can both be changed or revoked at any time

What are the possible consequences if I do not create an Advance Directive?

Without an Advance Directive including a Living Will and Health Care Agent (POA) to speak on your behalf, several unfortunate things could happen.

You might be given treatments that you never would have wanted if you were alert.

Your loved ones might not know your true wishes. They may become confused or disagree about what treatments you wanted based only on what you may or may not have said in the past. (clumsy, reword) This could cause unwanted emotional stress and conflicts.

Such disputes might delay decisions about getting immediate care and treatment such as comfort measures, and this could prolong your suffering.

Also, unnecessary or unwanted treatments could create a financial burden.

Can I still make my own decisions after I fill out an Advance Health Care Directive?

Yes. Only when you are unable to make decisions for yourself does your Living Will take effect. Your Health Care Agent will also be asked to make medical decisions on your behalf.

Also, a Living Will and Health Care Power of Attorney can both be changed or revoked at any time

What are the possible consequences if I do not create an Advance Directive?

Without an Advance Directive including a Living Will and Health Care Agent (POA) to speak on your behalf, several unfortunate things could happen.

You might be given treatments that you never would have wanted if you were alert.

Your loved ones might not know your true wishes. They may become confused or disagree about your desired treatments based only on what you may or may not have said in the past. This could cause unwanted emotional stress and conflicts.

Such disputes might delay decisions about getting immediate care and treatment such as comfort measures, and this could prolong your suffering.

Also, unnecessary or unwanted treatments could create a financial burden.

What are the health care options covered by my Advance Health Care Directive?

Here are common directives and situations to consider when completing an advance directive:

Do Not Resuscitate Order (DNR)

Also called Do Not Attempt Resuscitation (DNAR). If a person stops breathing or their heart stops, medical personnel are required to make every effort to keep the person alive using cardiopulmonary resuscitation (CPR). This includes chest compressions, intubation, drugs, or a defibrillator. However, you may not want to be resuscitated in most or all situations. To prevent any resuscitation attempts, you can sign a DNR order which means “I do not want CPR.”

Do Not Intubate Order (DNI)

Sometimes a person stops breathing but their heart continues beating. A tube may be placed in the airway (called intubation) so a mechanical ventilator can breathe for them. A DNI Order states that if breathing stops, you do not want to be put on a ventilator. So CPR may still be performed, but only chest compressions, cardiac drugs, and a defibrillator may be used to restart the heart.

Do Not Hospitalize Order (DNH)

In some situations, a hospitalization could be a traumatic experience or carry risk of exposure to disease. For example, a frail nursing home resident with dementia may find an ambulance ride and a hospital visit a very frightening ordeal. The purpose of a DNH Order is to opt out of an emergency room or hospital visit, instead allowing outcomes to unfold naturally while providing appropriate Comfort Care. A DNH is a reasonable option for many.

Life Support

There are life-prolonging devices that work as a temporary replacement for failing organs like kidneys or lungs. Consider what situations you may want equipment used to keep your body alive. Should life support be started only if there is reasonable hope of recovering full functionality? If your kidneys fail, do you want a dialysis machine used? If you cannot breathe on your own but might recover, do you want to be placed on a ventilator which breathes for you? These difficult questions should be considered. The My Catholic Doctor team can discuss these options with you.

Artificial Nutrition and Hydration (ANH)

This is another type of life support that is used when a person cannot take nourishment by mouth. This can occur with swallowing problems from head injuries or certain diseases. With ANH, fluids and nutrients are delivered directly into the stomach by a PEG tube or into the bloodstream by IV. Artificial Nutrition and Hydration is intended to prolong life, which may not be consistent with your wishes if you are incapacitated or have a terminal illness. Many moral questions arise when carefully considering ANH. Click here for info about the ethics of ANH from a Catholic perspective.

Palliative (Comfort) and Hospice Care

The goal of this treatment is to keep a person comfortable and manage adverse symptoms. At the end of life, this is called Hospice Care. Common symptoms include pain, nausea, insomnia, shortness of breath, restlessness, and depression, among others. You can even specify how you want these symptoms to be addressed.

Organ, Eye, and Tissue Donation

Organ donation and transplantation saves lives and heals thousands of people every year. This noble and generous act is supported by most major religions. Many people elect to donate their organs after death to one or more persons with life-threatening conditions. You may also donate your body to a university for research or help in the education of medical students.

I am a Catholic. What are other considerations specific to my religious faith?

Sacrament of Anointing of the Sick

Mass of Christian Burial

Burial in Catholic Cemetery

Is a Living Will the same as a Will and Testament, Legal Will, or Living Trust?

Only Living Wills are health care documents in which you specify your medical preferences for life-prolonging or life-sustaining procedures and treatment wishes for the end of life.

A Simple Will, Legal Will, Will and Testament, Joint Will, and Living Trust are not Advance Directives and do not cover health care wishes. They are examples of estate planning documents that express how your property will be distributed after death.

My Catholic Doctor has partnered with My Catholic Will – which is the only online Catholic will-writing tool available. This partnership allows you to secure your legacy of faith and give hope to future generations of Catholics in a meaningful way…make Catholic health care available to more people….. (maybe someone can provide content here)

Visit mycatholicwill.com/mycathdoctor to start your will today and preserve your legacy.

Find a MyCatholicDoctor clinician to help guide you in making these decisions.

Find a Clinician Here

To POLST or not to POLST

I have a POLST document that my doctor signed. Is this the best type of Advance Directive since a physician signed it?

A POLST form is an Advance Healthcare Planning document that tells other healthcare clinicians what your treatment wishes are IN A MEDICAL EMERGENCY. These forms come under various names (POLST, POST, MOLST, MOST, COLST…) and are used in all 50 states.

Since a doctor or other provider (NP, PA) signs this document, it becomes a medical order that must be followed by other providers. It is called “portable” because it becomes part of your medical records and “travels with you” wherever you are getting care. However, POLST forms are not appropriate for healthy people. Rather, they are only intended for those with advanced frailty and the seriously ill, such as those with metastatic cancer or advanced dementia.

Unfortunately, there are many serious ETHICAL problems with POLST that Catholics should be aware of

1. You are not terminally ill. A POLST order could prevent other providers from using a simple treatment that could have easily saved your life. This could lead to your premature death when you would have made a full recovery.
2. These documents could override your own decisions regarding your Living Will and the persons you chose as your HCPOA to make decisions on your behalf.
3. In some states, a POLST may not require a patient’s signature. In other states, ANY doctor, nurse practitioner, or PA may validly sign a POLST, instead of the patient’s primary doctor.
4. POLST orders are not regularly reviewed and may become obsolete. If your health has changed or your clinical condition has improved, outdated orders may lead to inappropriate treatment.
5. POLST forms usually state at the top: “FIRST follow these orders, THEN contact physician.” This requires a provider (like an EMT) to follow orders of a physician unknown to him. Again, the orders also may be obsolete (#3 above).
6. POLST legislation grants immunity to healthcare providers who act in “good faith” and are not subject to criminal or disciplinary proceedings. As a result, a provider could potentially ignore directives from a living will, family members, or your designated HCPOA.
7. POLST forms can be initiated by non-medical personnel (i.e. counselors, administrators, social workers). Unlike a physician, these individuals have no experience evaluating a patient’s complicated medical problems. There is also a bias from these unqualified “facilitators” toward refusing life-sustaining treatments.
8. POLST is an oversimplified checklist. Situations regarding healthcare and end-of-life decisions can be quite complex, and a check-box format cannot possibly account for all contingencies.

(refernced: www.cathmed.org/assets/files/NCBC_Article_on_POLST.pdf)

CMA 5-min Video, some PROS and CONS:

https://www.youtube.com/watch?v=1uv7vjY7APk

The Catholic Medical Association summarized the problems posed by POLST:

“In contrast to advocates of POLST, however, we believe that the use of POLST forms will create unacceptable risks from both the perspective of good medical decision-making and good ethical decision-making. Although we recognize that POLST might offer some benefits to some patients, the benefits will be grossly outweighed by the harms and abuses that will result from use of the POLST form.”
The Linacre Quarterly 80 (2) 2013, 103–138
https://www.cathmed.org/assets/files/LNQ59%20FINAL.pdf

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