People of faith turn to their religious tradition for guidance in making end of life decisions. The Catholic Church has rich teachings related to the mysteries of suffering, dying and death. The Catholic tradition provides principles for making decisions about initiating or continuing medical treatment and responsible preparations for dying and death. Central to the decision making process is the Catholic belief that life is a precious gift from God, and that it is given as a sacred trust over which humans have stewardship. Another important belief is that every aspect of life and death is part of ongoing relationships with God and neighbor. While there is a duty to preserve one's life, people have been created for eternal life in union with God. The Catholic tradition supports the refusal of life-prolonging procedures that are not beneficial or are excessively burdensome. The Church encourages prayer, reflection and dialogue with family and friends as health decisions are made.
Two examples of documents that have been prepared by State Catholic Conferences to assist people in completing advance directives are included here.
A Guide to Making Good Decisions for the End of Life: Living Will and Durable Power of Attorney for Health Care was prepared by the Washington State Catholic Conference and revised in 2006. It is available at www.thewscc.org.
The booklet includes:
- Letter from Archbishop Alex Brunett, Bishop William Skylstad, and Bishop Carlos Sevilla, SJ.
- "Living and Dying Well: Choices about Health Care" by Reverend Lawrence Reilly,
- Questions and Answers about End-of-Life Decisions
- Guides and forms for Durable Power of Attorney for Health Care and for Health Care Directives
- Guide for Making Funeral Plans.
While some information is specific to Washington state requirements, most of the information is general.
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Another helpful document was prepared by the Catholic Conference of Kentucky entitled Pastoral Letter: Kentucky's Advance Health Care Directives: A Catholic Perspective and is available at
http://www.ccky.org/Pastoral%20Resources/advance_healthcare_directives.htm
The pastoral letter describes advance directives in the light of the Kentucky 1994 Living Will Directive and Health Care Surrogate legislation and provides options to consider when preparing an advance directive. It also provides eight considerations from Catholic teachings. Practical considerations are also described for those choosing to designate a surrogate.
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Another resource is the Aging with Dignity document entitled Why Catholics Use Five Wishes. That document is reproduced here with permission.
The Five Wishes advance directive, featured in The Catholic Digest, Our Sunday Visitor, National Catholic Register, and other publications, has been very popular with Catholic hospitals, hospices, nursing homes, and parishes. Many communities of retired religious use Five Wishes, as well as a number of bishops and diocesan offices in America. More than 200 parishes have ordered the document, and more than half of those also ordered the video for religious education. Why is Five Wishes so popular with Catholic priests, religious, and the laity?
· Many other living wills and durable power of attorney forms are designed for people to say “no” to life support treatment. In other words, these documents are designed to communicate a decision to withhold or withdraw life support treatment. What makes Five Wishes so unique is that people can say “yes” or “no” to life support treatment, or permit the doctor to provide such treatment if it is helpful, but to stop it if it is not.
· Five Wishes contains a clear statement in opposition to euthanasia and physician-assisted suicide. In the section, “What You Should Keep In Mind As My Caregiver,” Wish Two, the document states for the person: “I do not want anything done or omitted by my doctors or nurses with the intention of taking my life.”
· Catholics distinguish between ordinary means and extraordinary means of care. Ordinary (or "proportionate") means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or on the community (ERD 56). Extraordinary (or "disproportionate") means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community (ERD 57). Catholic teaching specifically addresses nutrition and hydration.
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. – United States Conference of Catholic Bishops, Ethical & Religious Directives for Catholic Health Care Services, June 2001, no. 58. The problem is that most state laws define life support treatment in a broad way that includes both respirators and feeding tubes. Five Wishes solves this problem by providing places in Wishes One and Two for people to make this distinction and to define life support treatment in a way that is consistent with their faith. For example, a person may specifically write, “Decisions made on my behalf should follow Catholic Church teaching.” – or – “There should be a presumption in favor of providing nutrition and hydration, including medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved.”
· Five Wishes has a special focus on the spiritual needs of those who are seriously ill. It speaks of prayer, forgiveness, and reconciliation. Wish Five permits a person to request the sacraments of the Church and even to specify the songs and readings for their funeral Mass.
· The person who created Five Wishes, Jim Towey, worked for 12 years for Mother Teresa of Calcutta, and actually lived in one of her homes for the dying in Washington, DC. He received from His Holiness Pope John Paul II the Papal Cross (the Pro Ecclesia et Pontifice Award) on September 5, 2000, on the third anniversary of the death of Mother Teresa.
While Five Wishes is not a “Catholic-specific document,” it is used by many Catholics who desire to follow Church teaching on end-of-life care and express their preference in a legally valid and well-recognized document. Catholics who use it should consult with their local bishop or parish priest, or read appropriate literature, and learn more about the teachings of the Catholic Church on end-of-life care.
(More information is available about Five Wishes at www.agingwithdignity.org)