CATHOLIC ADVANCE HEALTHCARE DIRECTIVE
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Gain peace of mind by answering the hard questions about prolonged care, treatment and pain relief ahead of time
By Patrick Downes
Hawaii Catholic Herald
Your elderly mother is wheeled into the hospital emergency room with a broken hip. You’re handling her paperwork. Someone from the hospital asks if she has an “Advance Healthcare Directive.” You don’t think so. You are handed a blank one and instructed to have it filled out. You look it over. Amid the legal language and the blank lines to be filled in, three check-off questions stand out. “Do you want your life prolonged?” “Do you want nutrition and hydration?” “Do you want pain relief?” Mark “Yes” or “No.”
Yes or no? Is it all that simple? Your mom is a stanch Catholic. She asks if this has anything to do with that new physician-assisted suicide law the church is against. You don’t think so, but you’re not sure. Is this “directive” church-approved? Is there anything in it opposed to Catholic teaching?
As it stands, the Catholic Church is very much in favor of advance healthcare directives. However, it also recognizes that end-of-life situations are laden with moral issues. And so the Diocese of Honolulu has come up with a Catholic-friendly version.
The directive goes into effect when a person has an incurable or irreversible condition that will result in death in a relatively short time or when the patient has lost the ability to communicate his or her wishes.
Hawaii’s Catholic directive was approved by Bishop Larry Silva last December and will be introduced to the public in a series of 11 seminars from August to November at churches on all the major islands.
The three-hour sessions will be presented by Father Mark Gantley, the diocesan judicial vicar; Eva Andrade, executive director of the Hawaii Catholic Conference; Joy Yadao, a registered nurse and former director of St. Francis Hospice; and Jeannette Koijane, executive director of Kokua Mau, an non-profit organization that deals with elderly issues.
According to Father Gantley, he and others in diocesan positions had received questions about “moral issues” related to the Advance Healthcare Directive issued by the state of Hawaii, and concluded there was a need for a “Catholic version,” and some “teaching” to go along with it.
The Catholic healthcare directive received an additional push when Hawaii’s new physician-assisted suicide law, “Our Care, Our Choice,” went into effect on Jan. 1. Catholic teaching is morally opposed to physician-assisted suicide. Bishop Silva convened a task force to respond to the new legislation.
The committee, of which Father Gantley and Andrade were members, helped develop Bishop Silva’s “Instruction Regarding Sacraments and Funerals in Situations Involving Physician-Assisted Suicide.” Father Gantley led information sessions on the instruction earlier this year for clergy, parish staff, and those involved in ministry to the sick or in funeral ministry.
Father Gantley said that questions and concerns posed at the sessions showed a “great need” for an advance healthcare directive that would be legal in Hawaii and tailored for Catholics.
“There are a lot of misconceptions about end-of-life moral decision-making among our Catholic faithful,” he said. “We have not done a good job in teaching our people.”
Life and death experts
“The purpose for the existence of the Catholic Church is to get people into heaven,’ said Father Gantley, adding that “as Catholics, if we are experts in anything, we are experts in issues of life and death.”
The Catholic version of the directive “is a great tool for helping people grapple with end-of-life issues,” he said.
He said the Catholic directive will leave “all involved with a greater sense of peace and reassurance that decisions have been made that respect the law that God has written into our hearts.”
This directive does not address end-of-life questions with simple “yes or no” answers.
“We want to teach people how to start discussions about end-of-life decisions,” Father Gantley said, “and how to examine one’s life and one’s priorities to make the best medical decisions.”
Not everything is black and white, he said. “The Catholic Church teaches that a variety of options may be morally acceptable in choosing one’s care.”
These include palliative care, pain relief and hospice services “so that a person might die with authentic dignity.”
Death itself, however, is left to God.
The Catholic Advance Healthcare Directive’s first page briefly explains five areas of Catholic teaching related to death and dying. Three more pages complete the form with the following four parts:
Part 1 — Power of Attorney for Healthcare: Here is where you designate someone to be your “agent,” someone who will make decisions for you if you are unable to. It also asks for an alternate agent if the first agent is unable or unwilling to step in.
Part 2 — Instructions for Healthcare: Here is where you may, if you wish, go into detail about “what is important to you” — persons, things and activities of personal value that you would like to include in your end-of-life care. There is also space to add any further instructions regarding treatment, services, procedures, or anything else related to living your last days.
Part 3 — Organ Donation: This section gives instructions concerning which, if any, organs, tissues or body parts you may wish to donate after you die.
Part 4 — Signature and Witnesses or Notary Public: This is where the directive is signed by you in the presence of two witnesses, who also sign the document, or a notary public.
Hawaii’s priests have already gone through a four-hour session on the advance directive at their annual convocation in May. The upcoming parish sessions have been condensed to three hours.
Encouraging dialogue
Eva Andrade, executive director of the Hawaii Catholic Conference, the diocesan office that led the public fight against the new physician-assisted suicide law, said that, as she lobbied against the suicide bill, she was often asked for a Catholic alternative.
“This directive is part of that answer,” she said. “It was strategically developed to encourage deep dialogue by people of faith. We strongly encourage people to have healthy discussions with their family and friends that include our rich spiritual heritage.”
“This directive is a great way to do just that,” she said.
Andrade said that assisted-suicide laws are being passed in states across the country based on the fear of pain, of being a financial burden, and of the loss of autonomy.
The Catholic directive addresses these concerns.
“This directive gives people of faith the tools they need to ask the right questions and provide guidance to their doctor when and if the need should arise,” Andrade said.
“The very first page gets right to heart of the matter by providing the proper foundations for end-of-life decision making,” she said.
“With this guidance and familial support, fear can be alleviated,” Andrade said. “As the Bible reminds us, ‘Perfect love casts out all fear.’”
“Everyone should be having these conversations before any health crisis arises,” she said. “Decisions based on fear may cause someone to feel a subtle pressure to end their life early. Tough questions should be asked and with prayerful consideration, choices must be made.”
“We all hope and pray that our passing into eternal life will be free from anxiety and pain,” Andrade said. To assist in that, “our wishes need to be given, understood, and then carried out by those closest to us.”
The sessions
The Hawaii Catholic Conference, the public policy arm of the Diocese of Honolulu, is sponsoring a series of 11 seminars at churches on six islands from August through November on the new Hawaii Catholic Advance Healthcare Directive.
A four-person panel will give the three-hour presentation, “Our Faith, Our Freedom: Preparing Your Catholic Advance Care Directive.”
They are Father Mark Gantley, diocesan judicial vicar; Joy Yadao, registered nurse and former executive director of St. Francis Hospice; Eva Andrade, executive director of the Hawaii Catholic Conference; and Jeannette Koijane, executive director of Kokua Mau, a non-profit organization that assists the elderly and the seriously ill with end-of-life care.
The sessions are open to all adults, 18 and older.
Here is the schedule:
Oahu
- Saturday, Sept. 7, 9 a.m.-noon, Mary, Star of the Sea, Waialae-Kahala
- Tuesday, Sept. 10, 6-9 p.m., Co-Cathedral of St. Theresa, Kapalama
- Saturday, Oct. 5, 9 a.m.-noon, Resurrection of the Lord, Waipio
- Tuesday, Nov. 12, 6-9 p.m., St. John Vianney, Kailua
- Thursday, Nov. 21, 6-9 p.m., St. Jude, Kapolei
Kauai
Saturday, Aug. 24, 9 a.m.-noon, St. Catherine, Kapaa
Big Island
- Thursday, Oct. 3, 6-9 p.m., St. Joseph Church, Hilo
- Saturday, Nov. 23, 9 a.m.-noon, St. Michael, Kailua-Kona
Maui
- Thursday, Aug. 29, 6-9 p.m., Christ the King, Kahului
Molokai
- Thursday, Sept. 5, 6-9 p.m., St. Damien, Kaunakakai
Lanai
- Thursday, Sept. 26, 6-9 p.m., Sacred Hearts, Lanai City
The sessions will show participants how to discuss end-of-life decisions with a loved one, the moral aspects of end-of-life decisions, palliative care and hospice, and how to complete the new Hawaii Catholic Advance Healthcare Directive.
For more information, go to www.catholichawaii.org/hcc.
Questions and answers
Who is the Catholic Advance Healthcare Directive for?
The form is for all adults. While some may be in more urgent need to complete the form due to advanced age or certain medical conditions, it is recommended for anyone 18 or older.
I already have an advance healthcare directive. Can I replace it with this one?
It is recommended that your advance healthcare directive be reviewed and revised periodically. If you are happy with what you have, that is fine. But if you want to update your form, this one is available.
What distinguishes Hawaii’s Catholic directive from others?
The most significant difference is the first page, which gives general moral guidance on medical care and end-of-life decisions. Also, the Catholic form does not have “Yes or No” check-off boxes. The check-off boxes on other directives offer choices that may not be morally acceptable in all circumstances. For example, the statements “I want to have my life prolonged as long as possible” or “I want artificial nutrition and hydration” do not always have a simple “Yes” or “No” answer. Moral decision-making often falls somewhere in between. A judgment needs to be made by weighing the benefits against the burdens, which may allow for many possibilities.
Does the Catholic Church require life to be preserved in any way possible?
No, the church does not require extreme measures to preserve life in every circumstance. It does teach that a person, or his or her agent, should get as much information as possible about the prognosis, available treatments, and moral implications, weigh the pros and cons, and make a prudential judgment, without coercion or pressure.
May non-Catholics use the Catholic form?
The basic principles of Catholic moral teaching on life and death are based on the natural law of God written into our human hearts. So a nearly identical form designed for any Christian is offered by the Hawaii Family Forum, an ecumenical association. And with a few slight modifications, the form could easily be used by non-Christians.
Is this a legal document?
The form is a legal document in the State of Hawaii. It was reviewed by two civil attorneys who specialize in this area of law. The form contains specific legal language required by the State of Hawaii and also by federal law.
How obligated are doctors and family members to follow it?
In some states, there is a hierarchy of people who have a right to make decisions for another person’s healthcare if they become incapacitated. For example, one’s spouse might be first, then one’s children or parents, siblings, and so on. But Hawaii has the “ohana” system where anyone who shows up has a right to be heard. This makes it all the more important in Hawaii to have an advance healthcare directive, to avoid confusion and conflict. With a directive, there is a single person — an agent — authorized to make the decisions, and doctors are obligated to follow them. Ohana members may still give their opinions, but the single agent chosen by the person makes the decisions.
Are you required to appoint a spouse, child or parent to be the agent?
Many would feel inclined to do so, but it is not required. The agent should be someone who understands the person’s values and desires and who can make a good judgment in what might be very emotional circumstances. Often this might be someone other than a close relative.
