Advance Directives and End of Life Care
The SCL Health System (SCLHS) is committed to you and to providing health care that is safe, is of high quality, is in line with our Mission and Core Values, and respects the Ethical and Religious Directives for Catholic Health Care Services ("ERDs, Fifth edition, 2009). As persons make their health care decisions in the world today one of the common questions they ask is if Catholic health care will respect their advance directives for health care decision making. We appreciate the concerns that come with these questions.
Health care recognizes the significance of advance care planning with regard to patient safety and quality of care; patient and family satisfaction; critical conversations at the end of life; and costs associated with end-of-life care. Congruent with federal law regarding patient self-determination but anchored in respect for persons and their dignity, Catholic health care appreciates and respects the rights of persons to be fully informed about their health care and to have an advance directive (ERD #24).
Health care in the Catholic tradition is committed to treat persons with the utmost of respect and to act in ways that enhance and protect human dignity, especially in the vulnerability at the end of life. This profound respect for persons and human dignity is the foundation of the right to free and informed consent. Patients may choose to forgo treatments that "in the patient's judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community," (ERD #'s 56-57). Although health care in the Catholic tradition cannot honor advance directives whose intended purpose is to intentionally hasten death or end life, the ERDs respect advance directives.
The focus for SCLHS hospitals continues to be to provide exceptional care for our patients. Patients have the right to discern and make decisions about all matters in their health care, and we respect the right of persons to make their best decisions. As with any complex health care decision, we encourage you to clearly communicate your wishes with your family and your physician in advance to ensure they factor those wishes into decisions regarding your medical care.
A Summary of Catholic Health Care and End-of-Life Issues
Catholic health care ministry is rooted in a commitment to promote and defend human dignity; this is the foundation of its concern to respect the sacredness of every human life from the moment of conception until natural death. (ERDs, Part One, Introduction).
A Catholic health care institution will be a community of respect, love and support to patients and residents and their families as they face the reality of death. The task of medicine is to care even when it cannot cure. (ERDs, #1; Part Five, Introduction)
Congruent with federal law regarding patient self-determination but anchored in respect for persons and their dignity, Catholic health care appreciates and respects the rights of persons to be fully informed about their health care and to have an advance directive (ERD #24).
Reflecting the innate dignity of the human person, Catholic health care evaluates the use of technology so that it does not, in the best judgment of the patient, become excessively burdensome and that its withdrawal is not intended to hasten or cause death. (ERDs, Part Five, Introduction)
Euthanasia (an action or intention to cause death, or physician-assisted dying) is not permitted. (ERD #60)
In principle, there is an obligation to provide medically assisted nutrition and hydration if the benefit, in the patient's best informed judgment, outweighs the burden to the patient or resident. This obligation ceases if certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort. (ERD #58)
Health care decisions regarding benefit or burden refer to the patient's or their legitimate decision maker's judgment about the benefit or burden of a health care treatment. Decisions about benefit and burden do not refer to the quality of one's life. All persons have fundamental human dignity; persons are not to be regarded as a burden. (ERDs #'s 32, 55, 56, 57, 58, 59)
Effective management of pain in all its forms is critical in the appropriate care of the dying.(ERD #61)
Medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person's life so long as the intent is not to hasten or cause death. (ERD #61)
Additional Advance Planning Resources
(These resources are made available to assist persons in their personal advance care planning and do not represent an endorsement on behalf of SCLHS)
Catholic Health Association, "Advance Directives: A Guide to Help You Express Your Health Care Wishes"
National Catholic Bioethics Center (NCBC)
Supportive Care Coalition