End of Life Treatments and Documents: What You Need to Know
Right to Life focuses on issues where innocent human life is threatened both at the beginning and at the end of life. This is why we have concerns about Advance Medical Directives and POLST documents, which many patients with potentially life-threatening conditions may receive when they enter a hospital, hospice care, or nursing facilities. It’s important for our supporters to understand some of the benefits or threats posed by these documents, and how to prepare for making healthcare decisions for yourself or your loved ones.
An advance medical directive (sometimes called a living will or a healthcare power of attorney) is a document that allows you to designate someone as a medical agent to make decisions on your behalf (in the event you are unable to make medical decisions for yourself), and provide guidance about what kinds of treatments you do and don’t want to receive in the event of a future medical emergency.
A POLST (Physician’s Orders for Life-Sustaining Treatment) is a medical order for specific treatments you want to receive or not receive during a medical emergency, and is often given to a patient as he/she is admitted to the hospital or nursing facility in an end-of-life scenario. It has legally binding weight and doctors must follow it. It may have other names, like MOLST (Medical Orders for Life Sustaining Treatment).
There are certain risks associated with signing a POLST or an advance medical directive document. Patients can run the risk of binding themselves to courses of treatment they would not want to undergo, or even accidentally deprive themselves of basic care due to a lack of understanding of medical terminology.
Here are some basic pro-life concepts to consider when evaluating end-of-life treatments:
1. Always insist upon ordinary care; extraordinary care is not obligatory. “Ordinary” or “proportionate” care refers to treatments that have a high likelihood of helping the patient and are not unduly burdensome. This is the bare minimum that any patient deserves.
Many people misunderstand what pro-life advocates believe about end-of-life treatments. The pro-life position is not that every possible effort must be expended to ensure that every patient is kept alive at any and all cost. A pro-life perspective understands that death is a part of life, and that extending life is not an inviolable, end-all-be-all value that outweighs all other considerations. Certain treatments in an end-of-life scenario merely prolong death rather than foster life, and are either unlikely to succeed or are enormously burdensome (due to cost, pain, physical toll, etc.) to the patient. Thus, any treatment that is unlikely to succeed or is overly burdensome should be deemed “extraordinary” care, and may be employed at the discretion of the patient, or of an agent acting on the patient’s behalf. They are not a necessary part of basic care.
2. Nutrition and hydration—even via a feeding tube—are almost always ordinary care. Even if provided through artificial means like a feeding tube, nutrition and hydration is almost always basic care. People sometimes view a feeding tube as “life support” or as an extraordinary treatment. We have to realize that a feeding tube is an extraordinarily common and relatively simple form of care, and is often employed simply because it would be messy or difficult (but not impossible) to feed someone orally, or to avoid risks of a patient choking. It is an extraordinarily less invasive and traumatic intervention than, say, a respirator. Thus, when people say that they do not want survive by being “hooked up to machines” or “hooked up to tubes” at the end of life, we need to draw meaningful distinctions between tube feeding and more drastic forms of care.
There are certain instances where nutrition and hydration may not be necessary, or even may be harmful (for example, if death is immediately imminent or if the patient can no longer metabolize food and drink). However, outside of those circumstances, nutrition and hydration is almost always basic, ordinary care, and deliberately depriving a patient of such necessities can constitute euthanasia by omission.
We should remember the case of Terri Schiavo, the brain-injured but otherwise healthy woman whose husband suspiciously “remembered” that she did not wish to live via a feeding tube. Because of his decision to withdraw tube feeding, in 2004 Terri tied an excruciatingly painful and prolonged death from dehydration and starvation.
This is why POLST documents and Advance Directives can have risks. Many such forms are not produced with a pro-life perspective, and contain care/treatment options whereby a patient could deprive him or herself of nutrition and hydration unduly, purely due to confusion or misconceptions about the nature of artificial feeding. This is why such forms must be evaluated extremely carefully.
3. Designate someone with medical power of attorney through an advance directive. It is impossible to foresee every possible medical eventuality, and this is why POLST and Advance Directive documents can have limited value. Often, neither patients themselves nor their advocates can predict what a patient’s preference might be near the end of life. Thus, we encourage our pro-life supporters to designate a trusted, pro-life loved one to have medical power of attorney in the event of a medical emergency where an individual cannot make healthcare decisions for him or herself. Before an emergency arises, a patient can communicate their preferences to such an advocate in advance, and can designate someone who shares their pro-life values. This can also help avoid divisions within a family, and establish clearly who has the authority to decide on the patient’s behalf.
4. You do not need to sign a POLST. If you do, fill it out carefully. If you receive a POLST document to be filled out upon entering a hospital or at a nursing facility, understand that you do not have to fill it out immediately. You, or the person whom you have designated to make decisions for you, should read it closely and carefully before filling it out and signing it. If at any time you disagree with something that was filled out earlier, you can revoke your POLST at any time. The POLST does not revoke any prior advance directives you have filled out that designate someone as having medical power of attorney. Generally, if you fill out a POLST and do not fill in any section of it, you are choosing by default the most extensive treatment option available within that section of the document—this could be a legitimate option for you. While using a POLST is not in and of itself a harmful idea, it may be best simply to grant a loved one whom you trust with medical power of attorney to make healthcare decisions for you throughout the process of the illness.
We at Right to Life would encourage pro-life supporters to download and fill out the Advanced Health Care Directive produced by the Roman Catholic Archdiocese of Los Angeles, available here with explanatory document here. While Right to Life is a non-sectarian organization, we believe the Catholic Church’s teaching on end-of-life care and human dignity are thoroughly consistent with our organizational beliefs on those topics, and are broadly shared by a wide variety of Christian denominations and non-Christian religions who similarly believe in the sanctity of human life.
By filling out this form in the presence of witnesses and having it notarized, you can provide guidance to healthcare professionals and your family about the kinds of care you would like to receive when you are unable to make healthcare decisions, with confidence that your human dignity will be respected and cherished, and that you will not “commit” yourself to something harmful. The form also gives you the ability to designate a loved one to exercise medical power of attorney for healthcare decisions on your behalf, should you be unable to make those decisions yourself.
If you ever have questions about filling out these documents, you can also contact us at Right to Life of Central California. We are here to help those who are considering these questions and provide moral guidance. Call us at 229-2229, or email us at firstname.lastname@example.org.