Medical and Legal Matters Addressed at Forum

By Eileen Dugan
The Sooner Catholic

 EDMOND — Four panelists sat at the front of the crowded parish hall at Saint John the Baptist Catholic Church. They were discussing the medical, theological, legal, and spiritual dimensions of the Catholic view of the end of life.

Two of the panelists, Krista Reyna and Shirley Cox dealt with the medical and legal issues. Reyna, the Program Manager for Ethics and Palliative Care at Mercy Hospital, talked about the importance of all adults having an advance directive for health care. This document, also known as a living will, is a legal statement that records an individual’s decisions about his or her end-of-life issues. Reyna urged those present to have a discussion about their end-of-life wishes with their families, now, before a life-threatening crisis occurs.

She said that in such a discussion difficult questions must be asked and answered. If these questions go unanswered in the present, it will be much harder for the family in the future “when tragedy strikes and the family has no clue as to what the patient’s wishes for end-of-life are”. Trying to think clearly in a crisis is difficult, she said. It is better to deal with the difficult questions now when everyone is thinking clearly.

Reyna said “the conversations one has with the patient are just as important as the documents themselves because, through these conversations, one gets a better understanding of why the patient selected the particular options he or she chose.

“Knowing first hand what the patient wants gives peace of mind to the family,” she said. “You can’t put everything in an advance directive. Having had these conversations with the patient will help in the future. The family will have these discussions to fall back on if they have to make other individual decisions further down the road.”

To sign an Advance Directive for Health Care in Oklahoma, a person must be of sound mind and 18 years of age or older and have signed the agreement willfully and voluntarily.

If the person has a terminal condition or is “persistently unconscious”, signing an advance directive authorizes the person’s attending physician or healthcare provider to withhold or withdraw treatment that “would only prolong...[the person’s] process of dying” and would allow the person to die a natural death.

An advance directive also authorizes the withholding or withdrawing of such treatment if the attending physician and another physician determine that the patient has an incurable and irreversible condition that “even with the administration of life-sustaining treatment” will cause death within six months. These same medical professionals can also withhold or withdraw treatment if the individual is incapacitated, having “an irreversible condition in which thought and awareness of self and environment are absent”.

Shirley Cox, an attorney and legislative advocate for Catholic Charities, spoke of the legal documents one needs concerning the end of life. “You have to have legal documents to back up what is desired,” she said. “Each of you should have three legal documents to cover you at the end of life: a Durable Power of Attorney for Health Care, and an Advance Directive for Health Care and Do Not Resuscitate form.

The Durable Power of Attorney for Health Care is the person you authorize to make medical decisions for you now if you should become incapacitated but are not in danger of death. “The law says that the Durable Power of Attorney explicitly excludes decisions at the end-of-life,” Cox said. “Your advance directive for health care covers your end-of-life issues. You need both an advance directive and a durable power of attorney.

“You would use the durable power of attorney if you were entering a nursing home, or if you were to be switched from one hospital to another,” Cox said. “The durable power of attorney needs to be signed by two witnesses who are not going to inherit from you,” she said. The durable power of attorney gives the person you have designated health-care powers only; you can revoke the durable power of attorney at any time if you wish to do so.

The document known as the Advance Directive for Health Care covers end-of-life issues only. You should sign an advance directive for health care if you are within six months of death and do not want life-sustaining treatments, Cox said.

“Nutrition and hydration [food and water] is a separate issue,” Cox continued. “In Oklahoma there is a presumption that people want that [nutrition and hydration]. This presumption can be overcome by medical advice if the person is in an irreversible state.”

 Catholics need to pay particular attention to the administration of nutrition and hydration when filling out an advance directive. Some people and some states think the employment of nutrition and hydration is “extraordinary means”, but Catholics believe it is normal care.

In Pope John Paul II’s address to the participants of the International Congress on “Life-sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas”, March 4, 2004, he said, “I should like particularly to underline how the administration of water and food, even when provided by artificial means [IVs, feeding tubes, etc.], always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory”. In other words, a patient should always be provided with food and water regardless of his or her condition.

John Paul continued, “Death by starvation or dehydration is, in fact, the only possible outcome as a result of ... [food and water’s] withdrawal. In this sense it ends up becoming, if done knowingly and willingly... euthanasia by omission.” Euthanasia is the killing of another person to relieve suffering and is always against Catholic teaching.

Cox explained that a part of the advance directive is the appointment of a Health Care Proxy: “a person you specify to decide your health care for you if you are unable to do so”.

Your health care proxy will take over your health decision-making if you are within six months of death, if you are in a persistent vegetative state, or if you have signed a Do Not Resuscitate form.

Your health care proxy should be carefully selected, for your life and/or your death may depend upon this person. Your health care proxy should be someone with whom you have discussed your end-of-life desires and in whom you trust, someone who understands completely what you want for the end of your life and who has your best interests at heart. There is a place on the Oklahoma Advance Directive for Health Care where you can write-in the name of your health care proxy.

“Your attending physician and another physician must determine if you are no longer able to make decisions concerning your medical care,” Cox said. When two doctors have determined that you can no longer make decisions for yourself, your health care proxy will make them for you.

Cox instructed those present to consider filling in an additional place on the advance directive form, the one indicating what, if any, anatomical gifts a person wishes to leave and to whom after he or she has died.

This portion of the Oklahoma Advance Directive for Health Care form entitled Anatomical Gifts offers the person the possibility of leaving his or her “entire body or designated body organs or body parts” “for purposes of transplantation, therapy, advancement of medical or dental science or research or education pursuant to the provisions of the Uniform Anatomical Gift Act.”

Cox told the group that the third type of end-of-life document one needs to consider, but not sign at this time, is the Do Not Resuscitate (DNR) form. The signing of this form indicates to “your physicians and all medical institutions who might care for you in the event of cardiac or respiratory arrest, [that] you do not consent to the administration of cardiopulmonary resuscitation (CPR) in any form.”

Cox cautioned the audience about the dangers of signing a Do Not Resuscitate form too soon. She said that unlike the Advance Directive for Health Care, which does not go into effect until two physicians have certified that a person’s condition is terminal, the Do Not Resuscitate directive goes into effect immediately. For this reason, the DNR form “should be signed only by someone who is terminal in his or her own mind and has made an informed decision that he or she does not want to be resuscitated in any circumstance.”

Cox suggested that Catholics work with their lawyers on all three health-care documents, or at least have their lawyers look at these documents to make sure they are enforceable.

For more information about end-of-life issues, go to the website of the National Right to Life Coalition at www.nrlc.org. Click on The Will to Live to the left of page 1. Then, click on Download the Will to Live Now!! at the bottom of page 2. Click on Oklahoma in the middle of page 3. There are eleven pages about the Oklahoma documents that further explain end-of-life concerns.

The medical and legal information below is summarized from the question-and-answer period at the end-of-life panel discussion at Saint John the Baptist Church:   

* A living will (Advance Directive for Health Care) signed in another state is not necessarily valid in Oklahoma. Check with your lawyer. You might want to sign new documents specifically for the state of Oklahoma.

* Store originals of your healthcare legal documents in your safety deposit box. Give copies to your doctors and healthcare providers, to your lawyer, and to your family members.

* Record the names of all persons to whom you give copies of your healthcare documents. If you should change your mind and decide to revoke the old documents and write new ones, you need to know who these people are so you can reach them with the changes.

* Share with your Health Care Proxy the kind of life you want at the end of your life. Make sure your proxy understands and will follow your wishes. Make sure the proxy gets the support of the rest of your family.