The life-and-death struggle between Bob and Mary Schindler and their son-in-law, Michael Schiavo, ended March 31 with the death of Terri Schindler Schiavo. The nation watched the emotional tug-of-war as the courts determined whether to remove the brain-damaged woman’s feeding tube. The Schindlers believed their daughter — who had been in a persistent vegetative state for 15 years — would want to be kept alive by a feeding tube due to her Catholic beliefs. Her husband disagreed, and a court order allowed the tube’s removal.
Many realized the heartbreak of the situation could have been avoided if Terri had taken steps while she was healthy to clarify her wishes about the end of her life. The case spurred renewed interest in documents known as advance directives, noted Sister of St. Joseph Patricia Schoelles.
“People took it as an opportunity to review for themselves what their own options and decisions were,” said Sister Schoelles, president of St. Bernard’s School of Theology and Ministry in Pittsford.
Why prepare?
Church teaching favors advance directives regarding end-of-life issues, and the Diocese of Rochester has actively encouraged Catholics to complete health-care proxy forms, said Jann Armantrout, diocesan life-issues coordinator.
"The church, by the very nature of its mission, has always been concerned with the ministry that a person is able to receive at the end of life," Armantrout said.
Catholics are not absolute vitalists, concerned only with keeping the organism of the human body alive, but neither do they believe in euthanasia or the direct killing of another human, Sister Schoelles said.
"We believe in eternal life. It’s on that belief that we make all our decisions about death," she said.
Sister Schoelles has given presentations about the church’s end-of-life teachings at several parishes around the diocese. Understanding these teachings is necessary for anyone who wants to prepare advance directives in accordance with the church’s views on death.
"We’re encouraged to be responsible regarding our death and decisions surrounding our death. These are important conversations if you want to have that input, and I think a responsible person would want to have that input," Sister Schoelles said.
Understanding directives
Powers of attorney, living wills, health-care proxies and do-not-resuscitate orders are the four basic types of advance directives, said Ross Lanzafame, an attorney who belongs to St. Cecilia Parish in Irondequoit. In late April he and Sister Schoelles teamed up to give a presentation at the parish on end-of-life issues and advance directives.
Granting someone power of attorney means you delegate transactional authority to that person — called an agent — and identify the transactions and the powers the agent has, he said. Most people, however, don’t realize that in New York state a power of attorney does not cover health-care decisions, he added.
A living will is a document in which an individual provides written instructions about his or her specific health-care wishes. Living wills are not fully recognized in New York, but they can be accepted by a court as evidence of health-care wishes if they meet certain requirements, Lanzafame said.
A living will’s effectiveness can be limited because it only includes instructions about specific situations, Lanzafame said. A living will also does not allow for the possibility of future medical discoveries, he said.
A health-care proxy allows an individual to appoint a trusted person as his or her health-care agent, who will make decisions on the individual’s behalf if he or she becomes incapacitated, Lanzafame said, adding that this is the preferred advance directive in New York state.
The agent is to make decisions based on the individual’s ethical and moral beliefs and wishes, which may be outlined on the health-care proxy form, stated in a living will or discussed with the agent, Lanzafame said.
Armantrout said the diocese has provided parishes with health-care proxy forms, information about advance directives and copies of Health Care Proxy: A Guide for Catholics. The guide was prepared by the New York State Catholic Conference in 1996 and provides information about the proxy law as well as Catholic teachings on end-of-life issues.
Lanzafame acknowledged that some people may be hesitant to appoint health-care agents because they are afraid of losing their own decision-making powers, but he noted that a health-care proxy only goes into effect when a doctor determines the individual can not make his or her own decisions. If a person was temporarily unconscious after a car accident, for example, the health-care proxy would be in effect until the person regained consciousness and could again make decisions for himself or herself, the attorney noted. An individual can also limit the agent’s authority in writing on the health-care proxy form.
Some people are hesitant to complete proxy forms because they are worried this will give their agents access to their medical records. A health-care agent only has the authority to look at an individual’s medical records in the event that the individual becomes incapacitated and only for the purpose of making medical decisions at that time, Lanzafame said.
After completing a health-care proxy form, it’s important for the individual to discuss his or her end-of-life beliefs and wishes with the health-care agent. These discussions should be continual because newly emerging medical discoveries and technologies could change one’s views, making a health-care proxy more valuable than a living will, Lanzafame said.
“A doctor can’t talk to a piece of paper, but they can talk to a health-care agent,” he noted.
Also on the proxy form, an individual must specify his or her wishes about artificial nutrition and hydration. According to New York’s health-care proxy statute, this is the only area where a health-care agent is not authorized to make decisions, Lanzafame said.
The last type of advance directive is the do-not-resuscitate order, or DNR. This order is signed by a doctor and placed in a patient’s medical records, Lanzafame said.
“It is important for people to know that the DNR does not mean do not care for," Lanzafame noted. "It just means we’re not going to use cardiopulmonary resuscitation to revive you if your heart stops.”
A DNR may be requested by the individual or his or her surrogate, and it must be signed by a physician, although Lanzafame said a doctor can refuse to do so. Depending on the situation, the surrogate can be a health-care agent, legal guardian, spouse, child, sibling or close friend. The order can be revoked by the patient or surrogate at any time.
The doctor will review the DNR every seven days for a hospital patient and every 30 days for a nursing-home patient. If the patient’s condition has improved, the doctor may revoke the order.
A variation of the DNR is the out-of-hospital DNR for people who don’t reside in hospitals or nursing homes. Lanzafame said this DNR should be kept in a visible place within the home, or else emergency medical technicians arriving at the home in case of an emergency are obligated to use cardiopulmonary resuscitation to revive the patient.
EDITOR’S NOTE: Health-care proxy forms may be obtained from doctor’s offices, hospitals and nursing homes, and also may be found here.
