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POLST and Catholic Moral Teaching

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Title: POLST and Catholic Moral Teaching


1
POLST and Catholic Moral Teaching
"Life, health, all temporal activities are in
fact subordinated to spiritual ends."
- POPE PIUS XII
  • Deacon Dan Gannon

2
Overview
  • Origins of Catholic Moral Teaching
  • Catholic Teaching On End of Life
  • What is POLST?
  • An Intrinsically Flawed Paradigm
  • The Correct Paradigm
  • Affirming Human Life

3
Church Documents
  • Evangelium Vitae Gospel of Life (JPII)
  • Declaration on Euthanasia (CDF)
  • JP II Address to International Congress
    "Life-Sustaining Treatments and Vegetative State
    Scientific Advances and Ethical Dilemmas". March,
    2004.
  • Ethical Religious Directives (USCCB)
  • Veritatis Splendor Splendor of Truth (JPII)
  • National Catholic Bioethics Center
  • MN and WI Bishops on POLST

4
To understand POLST One must first
understand Catholic teaching on end-of-life
treatments!
To understand POLST
One must first understand Catholic teaching on
end-of-life treatments!
5
Origins of Catholic Moral Teaching on End-of-Life
  • The Churchs ethical standards flow from her
    teaching on the dignity of the human person

which is under attack today under the form of
Euthanasia mercy killing abortion
reproductive technologies
6
Origins of Catholic Moral Teaching on End-of-Life
  • Our dignity We are made in the image and
    likeness of God! (Cf. Gen. 126)

Human life is the basis of all goods, and is the
necessary source and condition of every human
activity and of all society.
Declaration on Euthanasia
7
Origins of Catholic Moral Teaching on End-of-Life
  • Life is always a good
  • Evangelium Vitae n. 32
  • Dignity of life linked not only to ORIGIN from
    God, but also to its final END union with God
    in knowledge and love of Him. n. 38

8
Origins of Catholic Moral Teaching on End-of-Life
Life is sacred and thus inviolable. (n. 40)
Mans life comes from God it is his gift God
is the sole Lord of this life man cannot do with
it as he wills (n. 39)
  • what does it mean to say life is sacred?

9
Origins of Catholic Moral Teaching on End-of-Life
  • Thou shalt not kill. Ex. 2013

I confirm that the direct and voluntary killing
of an innocent human being is always gravely
immoral. (EV 57)
Christian Message Concerning Life not just a
commandment but the proclamation of the very
person of Jesus Christ, who came that they might
have life and have it abundantly (Jn. 1010)
10
Origins of Catholic Moral Teaching on End-of-Life
  • No one can arbitrarily choose whether to live or
    die the absolute master of such a decision is
    the Creator alone. n. 47

Human life finds itself most vulnerable when it
enters the world and when it leaves the realm of
time to embark upon eternity. The word of God
frequently repeats the call to show care and
respect, above all where life is undermined by
sickness and old age. n. 44
What is needed at end of life is love!
11
Origins of Catholic Moral Teaching on End-of-Life
  • When facing end of life decisions, we turn to the
    Church
  • For sound moral direction to inform decisions
  • For nourishment and healing via the sacraments
    and pastoral care
  • Eucharist
  • Reconciliation
  • Anointing

12
Catholic Teaching On End of Life
  • The temptation grows to have recourse to
    euthanasia, that is, to take control of death and
    bring it about before its time, "gently" ending
    one's own life or the life of others.

Euthanasia in the strict sense is understood to
be an action or omission which of itself and by
intention causes death, with the purpose of
eliminating all suffering. EV n. 65
CCC 2277
13
Catholic Teaching On End of Life
  • Euthanasia arises from a culture of death,
    using criteria of efficiency, productivity to
    judge the value of human life.
  • Materialism, relativism assumes no absolute
    truth ones own subjective intent

I confirm that euthanasia is a grave violation
of the law of God since it is the deliberate and
morally unacceptable killing of a human person.
Depending on the circumstances, this practice
involves the malice proper to suicide or murder.
(EV 65)
14
Catholic Teaching On End of Life
  • Moral Act
  • Object what kind of act?
  • Intention what is the purpose/motive?
  • Circumstances act done in a certain context

Some kinds (objects) of human acts are incapable
of being ordered to God because they radically
contradict good of the person called
intrinsically evil acts which are always wrong.
CCC 1749 et seq Veritatis Splendor - JPII
15
Catholic Teaching On End of Life
  • but I just want to relieve their suffering
  • A good intention does not make behavior
    intrinsically evil (e.g. murder), good or just.
  • Rom. 38 never do evil so good may come
  • Consequentialism

An act must be good in its kind, in good or
neutral circumstances and for good intention
16
Catholic Teaching On End of Life
  • Nutrition and Hydration must be provided.
  • Note ordinary care always includes food,
    water, bed-rest, room temperature and personal
    hygiene.

The administration of water and food, even when
provided by artificial means, always represents a
natural means of preserving life, not a medical
act.
JP II 2004
17
Catholic Teaching On End of Life
  • Hydration and nutrition are not morally
    obligatory when either
  • they bring no comfort to a person who is
    imminently dying or
  • they cannot be assimilated by a person's body.
    (aspiration, pneumonia, infections, etc.)

(ERD V, intro)
In principle, there is an obligation to provide
patients with food and water, including medically
assisted nutrition and hydration for those who
cannot take food orally.
ERD 58
18
Catholic Teaching On End of Life
  • Even if death is thought imminent, the ordinary
    care owed to a sick person cannot be legitimately
    interrupted.

CCC 2279
In sum, we must care for basic, life sustaining
needs of food and water and not omit or do
anything that causes death. Ordinary care is
interrupted only to give way to natural death
caused by something other than lack of nutrition
and hydration.
19
Catholic Teaching On End of Life
  • Extraordinary (disproportionate) means /
    treatments

A ventilator may be proportionate/ordinary for a
reversible pathology (e.g. pneumonia)
A person may forgo extraordinary or
disproportionate means of preserving life.
Disproportionate means are those that in the
patients judgment do not offer a reasonable hope
of benefit or entail an excessive burden, or
impose excessive expense on the family or the
community.
20
Catholic Teaching On End of Life
  • Extraordinary means of preserving life are
    optional and legitimate to refuse.
  • Ceased to benefit or become burdensome
  • It needs to be determined whether the means of
    treatment available are objectively proportionate
    to the prospects for improvement.
  • Physician advises with medical opinion and
    patient decides

E.g. Chemo treatment for very elderly person
could constitute disproportionate means but
for a young person proportionate
21
Catholic Teaching On End of Life
  • Discontinuing medical procedures that are
    burdensome, dangerous, extraordinary, or
    disproportionate to the expected outcome can be
    legitimate it is the refusal of "over-zealous"
    treatment.
  • E.g. some cancer treatments, procedures
  • Here one does not will to cause death one's
    inability to impede it is merely accepted.

CCC 2278
Omission of ordinary means is euthanasia but
omission of extraordinary means is not
euthanasia. Cf. ERD 56
22
What Is POLST?
  • Physician (or Provider) Orders for Life
    Sustaining Treatments
  • One page form checkboxes of end of life
    treatment choices
  • Binding medical orders
  • Need not be signed by patient
  • Originated in 1990s at OHSU - publisher of
    Oregon Death with Dignity Act A Guidebook for
    Health Care Professionals.
  • POLST is actively promoted by Compassion and
    Choices (i.e. formerly Hemlock Society)

23
(No Transcript)
24
POLST Intrinsically Flawed Paradigm/Model
  • Circumstances can determine whether an act is
    morally sound or is euthanasia.
  • POLST model allows designation of future
    treatments outside of the actual circumstances
    of health conditions (pathologies)

25
POLST Intrinsically Flawed Paradigm/Model
  • Determining whether treatments are proportionate
    or disproportionate necessarily requires an
    analysis of the actual clinical condition of the
    patient in the particular circumstances.
  • Hence, then, here is the crux of the POLST issue
    circumstances can determine whether an act is
    morally sound or is euthanasia. A particular
    medical intervention could be either morally
    obligatory or morally optional depending on the
    medical circumstances.

Ethics Medics 2/13
26
POLST Intrinsically Flawed Paradigm/Model
  • WI Bishops

Because we cannot predict the future, it is
difficult to determine in advance whether
specific medical treatments, from an ethical
perspective, are absolutely necessary or
optional. POLST oversimplifies these decisions
and bears the real risk that an indication may be
made on it to withhold a treatment that, in
particular circumstances, might be an act of
euthanasia
27
POLST Intrinsically Flawed Paradigm/Model
  • MN Bishops

The form does not reflect the patients
underlying rationale for weighing treatment
options that would inform real-time decisions in
changing circumstances From a Catholic
perspective, making a morally sound decision
regarding end-of-life care calls for informed
consent based on information related to the
actual circumstances and medical conditions at a
particular moment.
POLST considers neither
28
POLST Intrinsically Flawed Paradigm/Model
  • Lack of informed consent of patient no
    signature required
  • FIRST follow these orders, THEN contact the
    patients provider
  • Becomes binding/effective immediately
  • Viz. treatments selected before unknown future
    health changes
  • Does not assure that the treatment decisions it
    orders are appropriate to the current condition,
    prognosis, and needs of the patient

29
POLST Intrinsically Flawed Paradigm/Model
  • Potential conflict with advance directive, health
    care agent
  • Does not require terminal illness
  • Makes individual autonomy an absolute
  • Poses morally grave choices in a form that lacks
    any context

In sum, the error intrinsic to POLST is that the
POLST paradigm prescinds from the actual
circumstances and their evolution, which are
indispensable for correct moral judgments at the
end of life.
30
NCBC on POLST
  • We urge Catholic health care institutions to
    refuse to accept POLST forms.
  • POLST forms pose unacceptable risks to the
    well-being of patients and the ethical values of
    Catholic health care.

POLSTis flawed because it disallows appropriate
reflection based on actual events that is, in
the moment medical decision making and so binds
the hands of doctors even when they have grounds
for questioning its utility.
Cf. NCBC Ethics Medics, Jan 2012
31
The Correct Paradigm
  • An advance directive with a designated health
    care agent is an intrinsically sound Catholic
    paradigm.
  • It only becomes operative/binding when
    potentially terminal conditions arise or when one
    becomes incapacitated.
  • It provides general principles for decision
    making to be followed, based on the Ethical 7
    Religious Directives of the USCCB.
  • We apply Catholic ethical principles to the
    actual circumstances!

32
Thank You!
www.catholicseniorservices.org (click on
Catholic Documents link) www.mncc.org (click on
Resources then healthcare directive)
www.archspm.org Office of Marriage Family and
Life 651-291-4506 Sharon Wilson Respect Life
Coordinator wilsons_at_archspm.org
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