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The Gift Of Life Informs My Conscience On Life-Sustaining Treatment And Care

“Human life and death are thus in the hands of God, in His power: ‘In His hand is the life of every living thing and the breath of all mankind,’ exlaims Job (12:10)... He alone can say: ‘It is I who bring both death and life’ (Dt 32:39)” (Evangelium Vitae 39).

My Guiding Beliefs About My Health Care

If I am no longer able to make my own health care decisions, my Health Care Agent should know that the following specific beliefs inform my conscience about how I want to be treated by health care professionals and what sort of medical care and services I want:

• As a Catholic, I believe that human life is a gift from God in which God shares something of himself with the person he creates. Without God sharing his own life with me, I would not exist. ⁵
• Because I share the gift of life with God my creator, I do not have absolute control over this gift. I am endowed with a free will, but by giving me life, God retains ultimate authority about how I should act toward the gift of life. ⁶
• In giving life to me, God asks that I be a good steward of life and act according to the purposes for which life is created. ⁷ This is why I choose to be a good steward of God’s gift and expect my Health Care Agent to act in the same way.
• In respecting the gift of life, I must conserve my life with treatment and care that are appropriate for the particular condition of my health. ⁸ This means that I and my Health Care Agent have a responsibility to avoid the extremes of euthanasia on the one hand and over-zealous treatment and care on the other. ⁹

What I Want In General If I Am Unable To Make Decisions

• Life-sustaining treatment and care includes any measure without which I would not be able to live. New Hampshire law states that life-sustaining treatment “includes, but is not limited to, the following: mechanical respiration, kidney dialysis or the use of other external mechanical or technological devices. Life sustaining treatment may include drugs to maintain blood pressure, blood transfusions, and antibiotics” (RSA 137-J:2 XIII).
• I have a moral option either to use or not use treatments or forms of care that have no reasonable hope of benefiting me or are an excessive burden on me or are an excessive expense for others to provide them (this is called ethically disproportionate treatment and care, which is defined below). ¹⁰
• I have a moral obligation to receive treatments or forms of care that have a reasonable hope of benefit for me and will not cause an excessive burden (this is called ethically proportionate treatment and care, which is defined below). ¹¹
• I want all such treatment and care that has a reasonable hope of benefit for me and will not cause an excessive burden.
• I do not want life-sustaining treatment or care that has no reasonable hope of benefit for me or will be excessively burdensome.
• I am responsible (or my Health Care Agent on my behalf) for making the judgment as to whether a treatment or form of care has a reasonable hope of benefit for me, or is an excessive burden. At the same time, I and my Health Care Agent have an obligation to base this judgment on all the factors mentioned in the definitions in the box below. My judgment about these matters is expressed in this DPAHC and will be carried out by my Health Care Agent.

What I Want In Particular If I Am Unable To Make Decisions

• My specific intentions for my medical treatment and care should I lack the capacity to make health care decisions are stated below and should be respected, adhered to, and interpreted by my Health Care Agent in light of the attached document, Three Beliefs .
• If my Health Care Agent judges that a particular life-sustaining treatment or form of care, or medically administered nutrition or hydration, does not have a reasonable hope of benefit or will be an excessive burden and should be withheld or withdrawn, then I want continued any other life-sustaining measure already in use that does have a reasonable hope of benefit and will not be an excessive burden.
• If my Health Care Agent judges that all life-sustaining measures or medically administered nutrition or hydration have no reasonable hope of benefit or are excessively burdensome and should be withheld or withdrawn, then I want all appropriate palliative care to continue because it is reasonable care in this situation and not excessively burdensome (see box below). This includes hospice care, but it does not include any action or withholding of care with the direct intention of hastening my death.
• If in the judgment of my Health Care Agent a treatment has a reasonable hope of benefit and will not be excessively burdensome as these terms are explained in Three Beliefs , then my Health Care Agent has a moral obligation to authorize such treatment even over my objection when I lack the capacity to make decisions.

Ethically proportionate treatment and care have a reasonable hope of benefit for the patient based on his or her condition, what the doctors expect, and how the patient responds to the treatment or care. This type of treatment and care is also not excessively burdensome for the patient. For example, such treatment and care do not cause serious medical complications and are not intensely distressful for the patient. This type of treatment and care also does not pose an excessive expense on the patient’s family or the community. A person is morally required to use this type of treatment and care. Ethically disproportionate treatment and care have no reasonable hope of benefit because, for example, they will not adequately achieve their purposes, or carry significant risk relative to the expected outcome, or because death is “imminent and impending” (this could be interpreted to mean that despite life-sustaining treatment and care, death could be expected to occur in a matter of days to approximately a week). Treatment and care are also ethically disproportionate if they will likely cause an excessive burden such as serious medical complications, or some other significant burden for the patient such as unavoidable intense distress, or they pose an excessive expense on the patient’s family or the community. A person is not morally required to use this type of treatment and care. To illustrate the general difference between ethically proportionate and ethically disproportionate actions, examples can be taken from the care of a newborn child and the education of children. There is a moral obligation to provide a newborn child with mother’s milk or appropriate baby formula, adequate clothing, proper care, and love. This obligation continues with all other necessities of life as the child grows. However, there is not an obligation for parents to provide only the finest and most expensive food and clothing. Another example may be taken from the obligation of parents to educate their children. This obligation is satisfied by ensuring that children receive the education they need to become responsible and productive members of society. However, this does not mean that parents are obligated to provide their children with the most expensive education, or with a program of learning that is beyond their capabilities.

• My moral obligations regarding life-sustaining treatment and the medical administration of nutrition and hydration can be met by receiving this treatment or care from competent medical professionals. If, according to appropriate medical standards, these professionals include Advance Registered Nurse Practitioners (“ARNPs”), then I have a moral option to grant them powers for this treatment or care.
• If I am permanently unconscious, I want medically administered nutrition and hydration until such time that my Health Care Agent judges that it no longer provides a reasonable hope of benefit or is excessively burdensome. ¹² Catholic teaching recognizes that this care is ethically extraordinary for someone in a “vegetative" or “permanently vegetative” state if the body can no longer assimilate the nutrients, it causes significant physical discomfort, or on rare occasions if it is excessively burdensome. ¹³
• Medically administered nutrition and hydration has no reasonable hope of benefit or is excessively burdensome, and is not what I want, if my death is imminent and impending, or if any of the following conditions occur as a result of this care:
  • it will not provide adequate nourishment;
  • my body cannot assimilate it;
  • it will likely cause hydrocephalus;
  • it causes recurrent aspiration-associated pneumonia, or respiratory distress;
  • it causes severe pain, distress, agitation, or complications which cannot be addressed by any reasonable remedy.
• If it is judged that cardiopulmonary resuscitation will either not have any reasonable hope of benefit or will be an excessive burden, then a Do Not Resuscitate order is morally justified because it prevents what would be ethically disproportionate.
• I want all appropriate pain medication to control pain even if in the course of directly treating my pain, the medication indirectly hastens my death. This result does not mean that I am violating my obligation to respect life or to be a good steward of the gift of life. ¹⁴
• Knowing the power of Jesus Christ to heal and strengthen my body and soul in the Sacraments, I would like a visit from a priest, that I may have the opportunity to receive the Sacrament of Penance, the Sacrament of the Anointing of the Sick, and, if I am able, Viaticum, (the Eucharist). I would also like the priest to be called to be available to attend to any other spiritual need, either for myself or my family.

Palliative care for the actively dying patient focuses not on cure but on providing relief from pain and the symptoms of disease through nursing or comfort care, and includes care for the psychosocial and spiritual needs of the patient.

Donation of Organs

After death has been declared by either cardiopulmonary criteria or by neurological criteria for death of the whole brain (including the brain stem), the donation of organs (for transplantation, medical education, or medical research consistent with Catholic teaching) is a charitable act and does not violate my obligations of good stewardship. ¹⁵

A check mark indicates what I desire:

___ I want my organs to be donated after I have been declared dead, either after my heart and lungs have irreversibly stopped functioning, or after my entire brain (including the brain stem) has irreversibly ceased to function determined by appropriate neurological criteria.
___ If I have sustained an irreversible traumatic brain injury and all life sustaining treatment and care is judged to be ethically disproportionate apart from my decision to donate organs, then:

• Medical preparations of my body may be made in anticipation of collecting my organs after I have been certainly declared dead by cardiopulmonary criteria, but no such preparations may be undertaken that will hasten my death.

For additional moral commentary on the New Hampshire Durable Power of Attorney for Health Care, Living Will, and disclaimer statement please contact the Diocese of Manchester. Diocese of Manchester 153 Ash Street P.O. Box 310 Manchester, NH 03105 603-669-3100 www.catholicnh.org

⁵ See Pope John Paul II, The Gospel of Life (1995) [Online] (Available: http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae_en.html ), ns. 34 and 39.
⁶ See Catechism of the Catholic Church, n. 2258; The Gospel of Life, ns. 39, 40, 53
⁷ See The Gospel of Life, ns. 52, 43, 48, 22; Catechism of the Catholic Church, n. 2288.
⁸ See The Gospel of Life, n. 65; Catechism of the Catholic Church, n. 2278.
⁹ See The Gospel of Life: “Euthanasia in the strict sense is understood to be an action or omission which of itself and by intention causes death, with the purpose of eliminating all suffering. ‘Euthanasia’s terms of reference, therefore, are to be found in the intention of
the will and in the methods used’ [quoting Sacred Congregation for the Doctrine of the Faith, II (1980) [Online] (Available: http://
www.vatican.va/roman_cura_congegations_cfaith_documents/rc_con_cfaith_doc_19800505_euthanasia_en.html )]. Euthanasia must be distinguished from the decision to forego so-called ‘aggressive medical treatment’, in other words, medical procedures which no longer correspond to the real situation of the patient, either because they are by now disproportionate to any expected results or because they impose an excessive burden on the patient and his family.”
¹⁰ Catholic teaching and tradition recognizes that life-sustaining treatment or care can pose an excessive burden not only on the patient but also on the ability of the patient’s family or community to pay for them; see the Ethical and Religious Directives for Catholic Health Care Services, ns. 56 and 57.
¹¹ See Ethical and Religious Directives for Catholic Health Care Services, ns. 56 and 57 and the Declaration on Euthanasia, IV for Catholic teaching on ethically proportionate and disproportionate means of sustaining life. It is important to note that the expectation that a treatment or form of care will achieve what it is designed to do without excessive burden is an example of what counts as a reasonable benefit.
¹² See Declaration on Euthanasia, IV; Ethical and Religious Directives for Catholic Health Care Services, n. 58; Pope John Paul II, “Life-Sustaining Treatment and Vegetative State: Scientifc Advances and Ethical Dilemmas” (March 2004), n. 4 [Online] (Available: http:/ www.vatican.va/holy_father/john_paul_ii/speeches/2004/march/documents/hf_jp-ii_spe_20040320_congress-fiamc_en.html ).
¹³ See Congregation for the Doctrine of the Faith, Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration and Commentary (August 1, 2007) [Online] (Available: http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20070801_risposte-usa_en.html ).
¹⁴ See Declaration on Euthanasia, III; The Gospel of Life, n. 65; Catechism of the Catholic Church, n. 2279; Ethical and Religious Directives for Catholic Health Care Services, n. 61.
¹⁵ See The Gospel of Life, n. 86; Catechism of the Catholic Church, ns. 2296 and 2301; Ethical and Religious Directives for Catholic Health Care Services, ns. 63 and 64.