October 29, 2009 // Uncategorized

Consider a healthcare representative rather than a living will

Question: What is the official Roman Catholic stance on having a living will? Recently my father-in-law died, who was a practicing Methodist, and he had a living will. I saw him die peacefully after he had a massive stroke. No I.V. or feeding tubes were ordered. When I mentioned this to my family, that is Catholic, they said that they didn’t believe that the Catholic Church would approve of that. After talking to several people, no one seems to know truly what the church’s stance is. Can you clarify? EG, South Bend

A living will is a document that outlines what you would want done if you should become unable to make your own healthcare decisions. Another type of advance directive is the appointment of a healthcare representative who would have the power to make healthcare decisions on your behalf.

Generally, the church is not favorable to living wills since they try to foresee what should be done in the future without knowing what the actual situation and the prognosis of the patient will be. For example, say a person has had a relatively mild stroke from which there is a good chance that he will recover. Now, imagine if he is unable to make his wishes known and his living will says no I.V. or feeding tubes, should his family allow him to become dehydrated or even die because he cannot properly swallow? A living will — even one of 30 or 40 pages — cannot cover all the situations in which a person might find himself.

The church, therefore, favors the appointment of a healthcare representative who is knowledgeable about the person’s wishes and is able to make ongoing evaluations and decisions based upon the actual situation and the prognosis of the patient. Such a representative would have to distinguish between care that is proportionate (which is ethically obligatory) and care that is disproportionate (which is not ethically obligatory). Disproportionate care is that which in the representative’s judgment does not offer a reasonable hope of benefit or which entails an excessive burden or expense. 

After a massive stroke and a very poor prognosis of survival, it is very possible that the reasonable course of action would be to withhold an I.V. or feeding tubes, which would only act to prolong the dying process or make it less comfortable. Such interventions could be judged at that point to be disproportionate care — though it is important to remember that the patient should eventually die as a result of the effects of the stroke, and not as a result of many days without any hydration. The problem with a living will is that you don’t know what your situation will be 10 or 20 years ahead of time. 

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