Catholic Bioethics
A
DVANCE
DIRECTIVES
 

  Nun consoling a Dysing Patient


5.5.1. Catechism on Consent (§ 2292-2296); 5.5.2. US Bishops ERD (§ 23-37); 5.5.3. Living Will; 5.5.4. Durable Power of Attorney; 5.5.5. POLST


AT present there are no Roman magisterial declarations on the right of Catholics to create advance directives, a document providing instructions on what is to be done when they can no longer express their wishes.  However the Catechism of the Catholic Church has reaffirmed Pius XII's declarations concerning the necessity of free, informed consent when medical procedures are experimental; and the U.S. Conference of Catholic Bishops have provided clear guidelines concerning advance directives in their Ethical and Religious Directives.

 4. Catechism on Life

 

 

 

 

 

 

1.  CATECHISM of the CATHOLIC CHURCH
on Life Issues

Bishop Exhorts Faithful

 

 

 

 

 

 


 

 

 

 

II. RESPECT FOR THE DIGNITY
of
PERSONS

II. Observantia
dignitatis personarum

 

 

 

 

2292 Scientific, medical, or psychological experiments on human individuals or groups can contribute to healing the sick and the advancement of public health.

2292 Scientifica, medicinalia vel psychologica in personis vel coetibus humanis experimenta conferre possunt ad aegrotorum sanationem et ad publicae valetudinis progressum.

2293 Basic scientific research, as well as applied research, is a significant expression of man’s dominion over creation. Science and technology are precious resources when placed at the service of man and promote his integral development for the benefit of all. By themselves however they cannot disclose the meaning of existence and of human progress. Science and technology are ordered to man, from whom they take their origin and development; hence they find in the person and in his moral values both evidence of their purpose and awareness of their limits.

2293 Investigatio scientifica fundamentalis et etiam investigatio applicata expressionem constituunt significativam dominatus hominis in creationem. Scientia et technica ars subsidia sunt magni pretii, cum in servitium adhibentur hominis et eius integralem promovent progressum in omnium beneficium; ipsae tamen, per se solas, exsistentiae et progressus humani nequeunt indicare sensum. Scientia et technica ars homini ordinantur, a quo ipsae originem sumunt et incrementum; in persona igitur et in eius valoribus moralibus indicatio finalitatis earum et conscientia earum limitum inveniuntur.

2294 It is an illusion to claim moral neutrality in scientific research and its applications. On the other hand, guiding principles cannot be inferred from simple technical efficiency, or from the usefulness accruing to some at the expense of others or, even worse, from prevailing ideologies. Science and technology by their very nature require unconditional respect for fundamental moral criteria. They must be at the service of the human person, of his inalienable rights, of his true and integral good, in conformity with the plan and the will of God.

2294 Fallax est moralem investigationis scientificae et eius applicationum neutralitatem vindicare. Altera ex parte, criteria viam indicantia neque ex mera technica efficacia possunt deduci neque ex utilitate quae inde quibusdam in aliorum detrimentum possunt provenire, neque, id quod esset peius, ex ideologiis praevalentibus. Scientia et technica ars requirunt, e sua propria intrinseca significatione, absolutam criteriorum moralitatis fundamentalium observantiam; illae esse debent in servitium personae humanae, eius iurium non alienabilium, eius boni veri et integralis, secundum Dei propositum et voluntatem.

2295 Research or experimentation on the human being cannot legitimate acts that are in themselves contrary to the dignity of persons and to the moral law. The subjects’ potential consent does not justify such acts. Experimentation on human beings is not morally legitimate if it exposes the subject’s life or physical and psychological integrity to disproportionate or avoidable risks. Experimentation on human beings does not conform to the dignity of the person if it takes place without the informed consent of the subject or those who legitimately speak for him.

2295 Investigationes vel experimenta in creatura humana non possunt legitimos reddere actus qui in se ipsis dignitati personarum et legi morali sunt contrarii. Subiectorum consensus, si forte detur, tales actus non iustificat. Experimentum in creatura humana moraliter legitimum non est, si vitam vel physicam et psychicam integritatem subiecti subire facit discrimina non proportionata vel evitabilia. Experimentum in hominibus dignitati personae conforme non est, si, praeterea, fit sine conscio consensu subiecti vel eorum qui ius in ipsum habent.

 

 

 

 

 

 


3. USCCB

 

 

 

 

 

 

3.  U. S. CONFERENCE of CATHOLIC BISHOPS

Bishops in Council

 

 

 

 

 

 

  PART FOUR

ETHICAL and RELIGIOUS DIRECTIVES
 for
CATHOLIC HEALTH CARE SERVICES 
  fourth edition


PART THREE:

The Professional-Patient Relationship


 

 

23. The inherent dignity of the human person must be respected and protected regardless of the nature of the person’s health problem or social status. The respect for human dignity extends to all persons who are served by Catholic health care.

 

 

24. In compliance with federal law, a Catholic health care institution will make available to patients information about their rights, under the laws of their state, to make an advance directive for their medical treatment. The institution, however, will not honor an advance directive that is contrary to Catholic teaching. If the advance directive conflicts with Catholic teaching, an explanation should be provided as to why the directive cannot be honored.

 

 

25. Each person may identify in advance a representative to make health care decisions as his or her surrogate in the event that the person loses the capacity to make health care decisions. Decisions by the designated surrogate should be faithful to Catholic moral principles and to the person’s intentions and values, or if the person’s intentions are unknown, to the person’s best interests. In the event that an advance directive is not executed, those who are in a position to know best the patient’s wishesusually family members and loved ones—should participate in the treatment decisions for the person who has lost the capacity to make health care decisions.

 

 

26. The free and informed consent of the person or the person’s surrogate is required for medical treatments and procedures, except in an emergency situation when consent cannot be obtained and there is no indication that the patient would refuse consent to the treatment.

 

 

27. Free and informed consent requires that the person or the person’s surrogate receive all reasonable information about the essential nature of the proposed treatment and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and morally legitimate alternatives, including no treatment at all.

 

 

28. Each person or the person’s surrogate should have access to medical and moral information and counseling so as to be able to form his or her conscience. The free and informed health care decision of the person or the person’s surrogate is to be followed so long as it does not contradict Catholic principles.

 

 


 

 


  3. LIVING WILL
 

 

 


The least helpful form of advance directive is a so-called living will, in which an individual tries to describe in some detail what they would like to have done for them when and if they are in a condition where they can no longer express their wishes.  The very serious problem with such documents is the fact that no one - not even health-care professionals - can anticipate all the possible circumstances and contingencies that may arise.  Most preferences are contingent and associated with uncertain probabilities such as:

 "If there is no possibility of my ever returning to consciousness . . ."  or

 "If there is no possibility that further treatment will result in a cure or in improvement in my condition . . ."

But such contingencies, even if accompanied by percentage survival-rates, are often impossible to reconcile with patients' wishes expressed in a living will.  Far better and more helpful to physicians is a document that designates a proxy decision-maker, such as a Durable Power of Attorney for Health Care


 

 


  4. DURABLE POWER of ATTORNEY
 

 

 


In this or any similar document in which one designates a proxy decision-maker the goal is to designate someone whose decision-making processes one trusts.  The person designating the proxy should share with that person their wishes and values, and choose someone able to act on those values when the time comes.  It is much easier for health-care professionals to work with a living proxy than with an inscrutable statement of wishes or intentions. [LA Archdiocese Brochure and Form: http://www.la-archdiocese.org/Pages/Publications/AHCD.aspx ]


 

 


  5. P.O.L.S.T.
 

 

 


In many states the difficulties attendent upon admission to a facility where one is not known have given rise in many states to the "Physician's Orders for Life-Sustaining Treatment" form.  This is most commonly filled out when an individual does not wish to have the full range of life-sustaining modalieties employed, such as chest-compressions and intubation.  The form must be signed by a physician who is responsible for the patient and who agrees that the listed measures should not be used.  Such forms are usually respected by emergency-response personnel; however, admitting physicians generally have the right to re-examine the patient to insure that what has been ordered on the form is in accord with their best medical judgment and the standards of care of the community.  The following is a commonly-used version of the POLST in the state of California in 2012:
 

 


POLST  FORM

 

 


HIPAA PERMITS DISCLOSURE of POLST to OTHER HEALTH CARE PROFESSIONALS as NECESSARY

Physician Orders for Life-Sustaining Treatment (POLST)

First follow these orders, then contact physician. This is a Physician Order Sheet based on the person’s medical condition and wishes. Any section not completed implies full treatment for that section. Everyone shall be treated with dignity and respect.

Last Name

First Name/Middle Initial

Date of Birth

 


A
Check One

 CARDIOPULMONARY RESUSCITATION (CPR):
Person has no pulse and is not breathing.

¨ Attempt Resuscitation/CPR

¨ Do Not Attempt Resuscitation/DNR (Allow Natural Death))

When not in cardiopulmonary arrest, follow orders in B, C and D.

B
Check One

 


MEDICAL INTERVENTIONS:
Person has Pulse and/or is breathing

¨ Comfort Measures Only Use medication by any route, positioning, wound care and other measures to relieve pain and suffering. Use oxygen, suction and manual treatment of airway obstruction as needed for comfort. Antibiotics only to promote comfort. Transfer if comfort needs cannot be met in current location.

¨ Limited Additional Interventions Includes care described above. Use medical treatment, antibiotics, and IV fluids as indicated. Do not intubate. May use non-invasive positive airway pressure. Generally avoid intensive care.

¨ Full Treatment Includes care described above. Use intubation, advanced airway interventions, mechanical ventilation, and defibrillation/cardioversion as indicated. Transfer to hospital if indicated.  Includes intensive care.

Additional Orders: _________________
________________________________

C
Check One

 


ARTIFICIALLY ADMINISTERED NUTRITION:
Offer food by mouth if feasible and desired.

¨ No artificial nutrition by tube.

¨ Defined trial period of artificial nutrition by tube.

¨ Long-term artificial nutrition by tube.

Additional Orders: _________________
________________________________
 

D
 

 

SIGNATURES AND SUMMARY OF MEDICAL CONDITION

Discussed with:

Patient Health Care Decisionmaker Parent of Minor Court Appointed Conservator Other:

Signature of Physician

My signature below indicates to the best of my knowledge that these orders are consistent with the person’s medical condition and preferences.

Print Physician Name    Physician Phone Number    Date

Physician Signature (required)    Physician License #

Signature of Patient, Decisionmaker, Parent of Minor or Conservator

By signing this form, the legally recognized decisionmaker acknowledges that this request regarding resuscitative measures is consistent with the known desires of, and with the best interest of, the individual who is the subject of the form.

Signature (required) Name (print) Relationship (write self if patient)

Summary of Medical Condition

 

 

SEND FORM WITH PERSON WHENEVER TRANSFERRED OR DISCHARGED


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