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Preparing for End-of-Life - Discern Moral, Medical Issues Ahead of Time

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January 20, 2016

Thinking about our own mortality is not easy.  It can be daunting as we consider the moral and medical discernments that often arise at the end of life.   For those very close to death, a tool is available to translate our wishes directly into orders to medical personnel.

Patients can use a Physician Orders for Life-Sustaining Treatment (POLST) to be very specific about what should and should not be done as they near death. When completed in consultation with medical personnel and a good understanding of Catholic teaching, the POLST can help us stay consistent with our faith as death approaches.  (For a copy of the form, click here.)

The POLST differs from advance healthcare directives, which do not guide emergency medical personnel, or a Do Not Resuscitate (DNR) order, which simply instructs not to treat. It is a "here and now" document for those who are already very close to the end of life.

"It is a legal and medical document that translates a patient's wishes into a physician's order," says Lori Dangberg, vice president of the Alliance of Catholic Health Care. This is in keeping with ERD 59 (see below), which requires the "free and informed judgment" by which a competent adult patient, or his surrogate, informs his conscience on a course of action in keeping with Catholic moral teaching.

For Catholics, especially, the POLST should be completed in accordance with Catholic teaching.  Two key sources can help – a competent, well-informed spiritual advisor such as a parish priest and the guidance provided by the Ethical and Religious Directives for Catholic Health Care Services (ERDs). 

(The ERDs, created by the Catholic Bishops of the United States, are actually intended to provide direction to medical personnel and institutions but they can be very helpful in understanding the Church’s teaching at end of life.) 

The POLST is "created" by a conversation between the patient and specified medical personnel, in which the patient is informed fully of his or her condition, treatment options and plans, and the benefits and risks of available procedures and medications.   

For instance, Catholics have a moral obligation to use "ordinary or proportionate means" of preserving their lives, if the means provides a "reasonable hope of benefit and do not entail an excessive burden, or impose excessive expense on the family or the community" (ERD 56).  If the patient feels the benefits are not reasonable, or entail an excessive burden, he or she may forgo those means (ERD 57). 

Once the form is signed by the patient or the patient's surrogate, the doctor, nurse practitioner or physician's assistant, it goes into effect immediately.  It can also be rescinded at any time which is critical if circumstances change.

Some have questioned the adherence of the POLST to Catholic teaching.  The Alliance of Catholic Health Care, however, points out that just the opposite is true:

“The POLST form may appear biased because its use is limited to very ill persons. As a result, the POLST most often reflects orders to forgo interventions, but that is due to the illness of the patient, not a bias of the form.  POLST allows this very ill patient population to choose for OR against different interventions that are likely to be considered given their health status.”  (Read the entire FAQ provided by the Alliance which details other questions Catholics might have.)

The portability of the POLST is a great boon. This document should be kept with patients at all times, and accompanies them everywhere--in an ambulance, to the hospital, to a skilled nursing facility, or at home. If no advanced directive, DNR, or POLST exists, emergency medical personnel are required by law to administer every possible treatment available to save or extend life.

And in light of the recent law, the End of Life Option Act (AB2X15), it should be noted that the POLST form contains no option for assisted suicide. "Assisted suicide is not in the spectrum of end of life treatment," says Dangberg.  

Judy Thomas, CEO of the Coalition for Compassionate Care of California which builds awareness of the POLST, sums it up succinctly: "POLST is a plan of care for the end of life. The End of Life Option Act is a plan of deliberately ending your life."

The Alliance for Catholic Health Care is a member of the Coalition and works to ensure that the POLST can be completed by patients consistent with Catholic teaching.

(Note:  The Coalition for Compassionate Care is not affiliated in any way with Compassion and Choices, formerly the Hemlock Society, which sponsored the physician-assisted suicide legislation.)

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