I would like to call to your attention Holy Redeemer's Making Your Own Health Care Decisions and its accompanying Advance Directive Form. These documents fail to specify 1) Catholic teaching with regard to nutrition and hydration and 2) that Catholic health care services cannot honor advance directives which are opposed to Catholic teaching:
- "As a competent adult, you have the fundamental right, in collaboration with your health care providers, to control decisions about your own health care. You have the right to make voluntary, informed choices to accept or refuse any treatment, service or procedure used to diagnose, treat or care for your physical or mental condition, including life-sustaining treatment.
"So long as you have the ability to understand the nature of your medical condition and the benefits, risks and burdens of the course of treatment and care recommended by your physician and its alternatives and are able to reach an informed decision, you have the right to make your own health care decision.
"If you should lose these abilities and become incapable of making your own decision, meaning that you have lost decision-making capacity, then your health care providers will look to your prior written advance directive and /or to family members to make decisions on your behalf. A determination that you have lost decision-making capacity MUST be made by your attending physician and as necessary, one or more additional physicians who personally examine you.
"Planning Ahead: Advance Directive for Health Care
"By writing an Advance Directive, you may exercise your right to plan ahead for, and control decisions about your health care in the event that you become unable to make your own decisions in the future. Your advance directive may be used to accept or to refuse any treatment, service or procedure used to diagnose, treat or care for your physical or mental condition, including life-sustaining treatment.
"You may choose among three types of advance directives:
"(1) By writing a Durable Power of Attorney for Health Care, you may designate another person, such as a family member or friend, to make decisions on your behalf.
(2) By writing a Living Will, you may state your directions and wishes for medical treatments you wish to accept or reject in certain circumstances.
(3) By writing a combined directive you may designate a health care representative to act on your behalf and provide him/her with a written statement of your treatment wishes.
"Please remember that you are not required by law to have an advance directive. If you choose to complete an advance directive, you may wish to consult your attorney, although an attorney is not required. You may choose to use the form provided by Holy Redeemer (see below), you may use a form obtained from another source, or you may write your own directive. It is not necessary to have an advance directive notarized.
"Holy Redeemer has developed a form for your use. Please click on the following link to open the PDF, which you can save to your computer: Advance Directive Form."
- "120....The administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him: their undue suspension could be real and properly so-called euthanasia" (Pontifical Council for Pastoral Assistance to Health Care Workers, Charter for Health Care Workers, 1995 )
- "I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering" (Address of John Paul II to the Participants in the International Congress on "Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemnas", 3/20/04).
- "The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented....A patient in a 'permanent vegetative state' is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means" (Congregation for the Doctrine of the Faith, Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration, 8/1/07).
- "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 [emphasis added]. 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 [emphasis added] 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 wishes—usually family members and loved ones—should participate in the treatment decisions for the person who has lost the capacity to make health care decisions.
"58. In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in chronic and presumably irreversible conditions (e.g., the 'persistent vegetative state') who can reasonably be expected to live indefinitely if given such care. Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be 'excessively burdensome for the patient or [would] cause significant physical discomfort, for example resulting from complications in the use of the means employed.' For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort" (USCCB, Ethical and Religious Directives for Catholic Health Care Services (5th ed), 11/17/09).