THE
CATHOLIC BISHOPS OF PENNSYLVANIA
Living Will and Health Care Power of
Attorney
What you should know about advance health
care directives
Dear Brothers and Sisters in Christ:
As Catholics, we believe that God
is the author of all life. We also
recognize the sacredness of human life from
the moment of conception to natural death.
For many years the Bishops of
Pennsylvania have provided information to
the Faithful about medical treatment at the
end of life and have encouraged the use of
advance directives for health care. Such a
document enables a person to give guidance
to another who will make decisions about
medical treatment or care.
Changes in Pennsylvania law have
prompted us to develop questions and answers
about authoritative Church teachings on
end-of-life issues and to prepare an advance
directive for health care for Catholics. By
completing a document that is consistent
with official Catholic teaching, you are led
to consider circumstances that involve
medical treatment and care, and to share
your beliefs and wishes with others. This
document will assist those who will need to
make decisions for you when you cannot
direct your own care. By taking this step,
you can eliminate misunderstanding and
confusion and appoint someone who will act
for you.
These materials set forth the
Catholic principles that apply to medical
treatment decision-making, explain the
combined living will and a health care power
of attorney documents and include a form
which is consistent with both Pennsylvania
law and authoritative Catholic teaching
including certain core principles:
r
We believe that we have a responsibility to
preserve our life. Euthanasia, which is an
act or omission which of itself or by
intention causes death, and/or assisted
suicide is morally wrong. (Declaration on
Euthanasia: Congregation for the Doctrine of
the Faith, 1980)
r
We believe there are some limited
qualifications to the obligation to attempt
to preserve life such as the refusal of
overzealous treatment, including medical
procedures that are burdensome, dangerous,
extraordinary, or disproportionate to the
expected outcome. (Catechism
of the Catholic Church, 1995, #2278)
r
Death is not to be feared as the end of our
existence, rather it is the doorway to our
eternal destiny.
r
A decision to forego a medical treatment
should not be made because a person’s life
is judged as not meaningful.
“There
should be a presumption in favor of
providing nutrition and hydration to all
patients, including patients who require
medically assisted nutrition and hydration,
as long as this is of sufficient benefit to
outweigh the burdens involved to the
patient.” (The Ethical and Religious
Directives for Catholic Health Care
Services, 2001, #56.)
We pray that you find this booklet
to be of help as you consider the important
issues covered. We pray, too, that you make
decisions relying on your Faith and knowing
that life eternal awaits.
Yours in Christ,
The Catholic Bishops of Pennsylvania
Pennsylvania law allows you to
designate someone to make health care
decisions if you cannot do it yourself. As
Catholics, we hold a special regard for the
dignity and sanctity of every human person,
especially in times of illness or at the end
of our earthly lives. It is therefore
important to ensure that the person you
designate to make health care decisions for
you applies the authoritative teachings of
the Catholic Church to these decision making
processes.
The Catholic Bishops of
Pennsylvania have prepared these responses
to frequently asked questions so that you
are informed about Catholic teaching on
health care decision-making. The advance
directive form included in this booklet
reflects authoritative Church teaching and
complies with Pennsylvania law.
What is an advance health care directive?
In
Pennsylvania, a health care directive can be
a living will, a health care power of
attorney or a written combination of the
two.
A living will is a written
document which sets forth a person’s wishes
and gives instructions about health care
when the person has an end-stage medical
condition, or is permanently unconscious.
A health care power of attorney
is a written document which designates
someone to make health care decisions for
you.
Why does the Catholic Church care about
advance directives?
The Church supports Pennsylvania law which
allows individuals to name an agent to make
health care decisions for them if they lose
the capacity to make or express their own
choices. For Catholics, health care
decisions should be made in the light of our
Faith. Morally correct decisions are based
on our respect for the sanctity and dignity
of life and acknowledge our dependence upon
God. Our decisions must be rooted in the
recognition that each of us is the steward
of the gift of our life. Advance directives
give Catholics a way to profess our Faith
and help to ensure that the decisions about
the care we receive when we cannot speak for
ourselves are made in accord with our
religious beliefs.
Why would I want a health care directive?
By completing a health care
directive, you can ensure that your wishes
concerning decisions about medical care are
followed if you are unable to understand,
make, or communicate those decisions for
yourself. Decisions which might be made
under a directive include the selection or
discharge of a health care provider; or the
approval or disapproval of a diagnostic
test, surgical procedure, program of
medication, or other extraordinary means of
medical treatment. An advance directive
provides an opportunity for you to make it
clear that you embrace Catholic values and
would rely upon the authoritative teachings
of the Church to guide your own decisions.
Advance directives can also provide
Catholics with an opportunity to provide
directions regarding pastoral and
sacramental care.
What happens if I don’t have a health care
directive?
If you do not appoint a health
care agent and you are unable to understand,
make or communicate for yourself, your
wishes about health care may not be known to
others. If this is the case, Pennsylvania
law says decisions about your care can be
made by a family member, or some other
individual who may or may not know your
specific preferences. The person the law
chooses (who would be called a health care
representative) may not be the one you
prefer. For example, you might prefer
someone other than a family member. You may
have a close friend who really knows you
better and would be better able to make
decisions on your behalf. But, to appoint
that person you must take steps to formally
name him or her as your health care agent.
Your health care agent or
representative must make health care
decisions in accordance with your
instructions based upon authoritative
Catholic moral teaching; but, if you do not
leave instructions, the agent will have to
assess the situation using whatever
knowledge he or she has of your preferences
and values, including your religious and
moral beliefs. If your health care agent or
representative does not know enough about
what you would want, he or she will have to
be guided by what he or she knows of your
values and use his or her own judgment to
deem what is in your best interest.
Can my agent authorize the discontinuation
of nutrition and hydration?
Pennsylvania law presumes that an
incapacitated person would not want assisted
nutrition or hydration to be withheld or
withdrawn unless the person indicated a
preference to the contrary specifically in
writing. This presumption created in
Pennsylvania law can also be overcome if the
designated health care agent knows of the
person’s previously clearly expressed
wishes to the contrary about assisted
nutrition or hydration.
What does the Church say about medically
assisted nutrition and hydration?
It is important to note that as
Catholics, we believe that God is the author
of all life. We believe that we (and our
health care agents) have a responsibility to
preserve life. In their statement,
Nutrition and Hydration: Moral
Considerations, the Bishops of
Pennsylvania said, “There are instances in
which it is relatively easy to apply moral
principles to the decision to withhold or
withdraw nutrition. In the case of a
terminal cancer patient whose death is
imminent, for instance, the decision to
begin intravenous feeding or feeding by
nasogastric tube or gastrostomy, may also
mean that the patient is going to endure
greater suffering for a somewhat longer
period of time - without hope of recovery or
even appreciable lengthening of life.
Weighing the balance of benefits versus
burdens makes it relatively easy to decide
that this could fall into the category of
extraordinary means and that such feeding
procedures need not be initiated or may be
discontinued.”
But these sorts of cases must be
distinguished from those in which a patient
is severely or chronically incapacitated but
not dying. According to the authoritative
teaching of the Catholic Church, a patient
should not refuse or discontinue medically
assisted nutrition and hydration that are
capable of sustaining life simply because he
or she has been diagnosed to be permanently
unconscious or in a chronic, non-terminal
condition.
Important guidance has been provided
by the Congregation for the Doctrine of the
Faith in its responses to questions posed by
the United States Conference of Catholic
Bishops concerning medically assisted
nutrition and hydration for a patient in a
vegetative state. The questions posed and
the responses provided are directly quoted
below.
First question:
Is the administration of food and water
(whether by natural or artificial means) to
a patient in a “vegetative state” morally
obligatory except when they cannot be
assimilated by the patient’s body or cannot
be administered to the patient without
causing significant physical
discomfort?
Response:
Yes. 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.
Second question:
When nutrition and hydration are being
supplied by artificial means to a patient in
a “permanent vegetative state”, may they be
discontinued when competent physicians judge
with moral certainty that the patient will
never recover consciousness?
Response:
No. 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.
1
At the same time, the Church
recognizes that simply because one starts to
give medically assisted nutrition and
hydration does not mean that they can never
be discontinued. A Commentary issued by the
Congregation for the Doctrine of the Faith,
advises that:
“[w]hen stating that the administration of
food and water is morally obligatory in
principle, [that] does not exclude the
possibility that, in very remote places or
in situations of extreme poverty, the
artificial provision of food and water may
be physically impossible… However, the
obligation to offer the minimal treatments
that are available remains in place, as well
as that of obtaining, if possible, the means
necessary for an adequate support of life.
Nor is the possibility excluded that, due to
emerging complications, a patient may be
unable to assimilate food and liquids, so
that their provision becomes altogether
useless. Finally, the possibility is not
absolutely excluded that, in some rare
cases, artificial nourishment and hydration
may be excessively burdensome for the
patient or may cause significant physical
discomfort, for example resulting from
complications in the use of the means
employed.
These exceptional cases, however, take
nothing away from the general ethical
criterion, according to which the provision
of water and food, even by artificial means,
always represents a natural means for
preserving life, and is not a therapeutic
treatment. Its use should therefore be
considered ordinary and proportionate,
even when the “vegetative state” is
prolonged.”
2
Pennsylvania’s Catholic Bishops also
published a thorough discussion of nutrition
and hydration entitled Nutrition and
Hydration: Moral Considerations,
(Revised Edition, 1999). Read it online at
www.pacatholic.org and click
“Bishops’ Statements” or contact the
Pennsylvania Catholic Conference for a copy.
Can’t I just trust a family member or friend
to make a good health care decision?
Most of us would naturally be
inclined to trust our loved ones with these
decisions. However, you provide a service
to your family and friends by letting them
know how you want to be treated. An advance
directive shows that you have thought
carefully about the issues and that you have
specific preferences that should guide
decisions with regard to the provision of
medical care. If you use the form approved
by the Bishops of Pennsylvania, you clearly
indicate that your Faith and the
authoritative teachings of the Church are to
be considered of the utmost importance when
decisions about your care are being made on
your behalf.
Do I need to use a special form?
You do not need a special form in
Pennsylvania. The advance directives
statute provides an optional form, but many
other forms meet Pennsylvania legal
requirements. In fact, it is not necessary
to use a pre-printed document at all; any
written form that explains your wishes and
complies with statutory signing requirements
can be used.
Is there a Catholic form?
There may be a number of
“Catholic” forms available. But, the
Bishops of Pennsylvania developed a
living will and health care power of
attorney form to clearly reflect
authoritative Catholic teaching about these
issues. Their form meets Pennsylvania legal
requirements.
This document is written with a
comprehensive understanding of the human
person and reiterates church teaching that a
human being never loses his or her dignity
regardless of physical, psychological or
relational circumstances. Catholics are
advised to use this form to avoid any
discrepancies with other forms that may not
necessarily follow authoritative Catholic
moral teaching.
Where can I obtain this approved form?
The approved form can be
downloaded and printed from the Diocese of
Scranton website at:
www.dioceseofscranton.org or the
Pennsylvania Catholic Conference website at:
www.pacatholic.org. A copy can also be
obtained by contacting David Clarke,
Diocesan director of social concerns and
pro-life, at 570-207-2213.
Do I need an attorney? Does this document
need to be notarized? Will this cost me
anything?
No. It is not necessary to have
an attorney to complete a form. However,
you should contact an attorney if you have
legal questions regarding advance health
care planning. This form does not need to
be notarized under Pennsylvania law, but
notarizing this form may make it more likely
to be accepted under laws in other states.
Advance directive forms are available from a
number of sources for no charge, including
the Pennsylvania Catholic Conference. The
form and this question and answer booklet
are not intended to take the place of
specific legal or medical advice.
Should I appoint a health care agent or just
write down my wishes?
By appointing a health care agent,
you can make sure that someone who cares
about you will apply your wishes and
personal beliefs to health care choices –
just as you would. Even if you appoint a
health care agent, you can still give
written health care instructions to direct,
guide, and even limit the actions of your
agent and, in this way, you can express the
importance of your Catholic faith and how it
applies to your health care decisions.
Having both a health care agent as well as a
written document is preferable to a written
document alone because the agent you
designate will interpret and apply your
directions to your particular health care
situation. A written document alone may have
to be subject to another individual’s
interpretation in your particular
circumstance.
What should I do with my health care
directive?
Give a copy of your health care
directive to your agent, your doctor and any
other health care providers such as your
hospital, nursing facility, hospice, or home
health agency. In addition, you may want to
give copies to others, such as close family
members, your priest, and your attorney, if
you have one.
How can I make sure that decisions made on
my behalf are consistent with my Catholic
beliefs?
ü
State in your health care directive your
desire to have all health care decisions
made in a manner consistent with
AUTHORITATIVE Catholic teaching.
The living will and health care
power of attorney from the Pennsylvania
Catholic Conference does this in a clear,
straightforward way.
ü
APPOINT A HEALTH CARE AGENT WHO SHARES YOUR
BELIEFS OR WHO YOU ARE CONFIDENT WILL
RESPECT YOUR WISHES.
If your health care agent is not familiar
with authoritative Catholic teaching on
these matters, tell your agent to seek
guidance from a parish priest, a Catholic
chaplain or the diocesan office in your
diocese which deals with issues like this.
The advance directive is an important
communications tool which clearly explains
what you believe, in your voice, even when
you cannot speak for yourself.
Are Catholics morally obligated to have an
advance directive?
No. However, an advance
directive, especially one that appoints a
health care agent, is one way to make sure
that your care and treatment is consistent
with the Catholic faith and your wishes.
Therefore, it is recommended that you
designate an agent.
How can I make sure my spiritual needs are
met?
When you enter a hospital, nursing
home or other health care facility, state
that you are a Catholic and want a priest or
pastoral minister to care for your spiritual
needs. Also, state if you want to see a
particular priest. Unless you have done
this, certain privacy rules may prevent the
hospital, nursing home or other health care
facility from informing your priest or
pastoral minister about your situation or
might not allow him or her to visit.
If you cannot communicate your
wishes when being admitted, your health care
directive and health care agent should be
authorized to do this for you.
If I already have a signed living will, do I
need to sign a new one?
No. Living will forms signed
before 2006 are still valid. However, the
new law passed in 2006 allows for a combined
form with both a living will and a
health care power of attorney. In
addition, terms used in the new law differ
from those used in many earlier versions of
living wills. Therefore, it is recommended
that you complete and sign the new form
provided by the Catholic Bishops of
Pennsylvania which includes both a living
will and a health care power of attorney,
and also uses the up-to-date terminology.
1 Congregation for the Doctrine of the
Faith: Responses to Certain Questions
of the United States Conference of
Catholic Bishops concerning Artificial
Nutrition and Hydration, August 1,
2007.
2 Commentary. Congregation for the Doctrine
of the Faith: Responses to Certain
Questions of the United States Conference of
Catholic Bishops Concerning Artificial
Nutrition and Hydration, September 15,
2007.
CHURCH RESOURCES ON END OF LIFE ISSUES
Patients in a “Permanent” Vegetative State
(Pope John Paul II, March 20, 2004)
Declaration on Euthanasia
(Congregation for the Doctrine of the Faith,
1980)
Nutrition and Hydration: Moral
Considerations
(The Catholic Bishops of Pennsylvania,
Revised Edition, 1999)
Ethical and Religious Directives for
Catholic Health Care Services
(U.S. Conference of Catholic Bishops, 2001)
Nutrition and Hydration: Moral and Pastoral
Reflections
(U.S. Conference of Catholic Bishops, 1992)
Responses to Certain Questions Concerning
Artificial Nutrition and Hydration
[Vegetative State]
(Congregation for the Doctrine of the
Faith, 2007)
