ADVANCED DIRECTIVES in HEALTH CARE: MAKING the BEST DECISIONS

Having considered the topic of advanced directives in health care in general, and the kinds of directives that can be made, let us draw some practical conclusions about what is to be done and when. Are there directives you should be making now, in advance of serious illness or injury? Are there directives you are better off postponing until you are diagnosed with serious illness or affected by serious injury? What are you to do?

Do Nothing?

Doing nothing is a decision you can make. If you do not make any directives about your health care in advance, and you become unable to make decisions about your own health care, a surrogate decision maker will be appointed. According to New York State law, that person would be (in order of priority): your legal guardian, your spouse or domestic partner, an adult child, a parent, an adult sibling, or a close friend. Most other U.S. states have similar laws. If you trust your spouse, adult children, or other default legal surrogates to understand your values and preferences and to be able to make good decisions on your behalf, doing nothing might not be such a bad decision. However, there are many reasons why delegating a health care agent could be a better decision.

Delegate a Health Care Agent?

By completing a health care proxy, and thereby designating a health care agent, you can ensure that, if you are unable to decide for yourself, the person making health care decisions on your behalf is someone you trust to do that well. Your designated agent will only be able to act on your behalf when you are incapacitated. When your agent is empowered to act, that person can generally make all the health care decisions you would otherwise make for yourself. You can also designate one or more alternate agents in case the first person or persons you designate are unable to assume that role. In addition to ensuring that the person who acts on your behalf is someone you trust, designating a health care agent can give your loved ones clarity about who will have final decision making responsibility, which could help to prevent confusion or conflict.

It is important that your health care agent have a clear understanding of your values and preferences. Perhaps the person you designate already knows you well and understands your wishes. Nevertheless, it is a good idea to speak with that person about the kinds of health care decisions that might need to be made. Some of those decisions, at least for Catholic Christians, have to do with what is always right and wrong. For example, we always want to have ordinary life sustaining care and we never want to do anything intended to cause death. Other decisions have to do with legitimate preferences. For example, you might not want to be resuscitated when you are terminally ill, or you might want to donate organs after your death. These are the kinds of things you should talk your health care proxy about. They are also the kinds of things you might include in a living will.

Make a Living Will?

By making a living will, you can indicate your preferences in a written document that has legal force. A living will can be a good way to ensure your wishes are carried out, but it can also lead to unintended wrongdoing. A directive written in advance of being carried out is incapable of accounting for the circumstances of the present. A written document can also be subject to conflicting interpretations. A term like “quality of life,” for example, might mean one thing to you and something else to the person who interprets you living will. Making a living will can be good, but you have to be careful to designate your preferences in such a way that they will not be misapplied. You should be even more cautious about designating health care preferences in a POLST form, since those preferences would take the form of doctor’s orders to be applied in unforeseen circumstances. For these reasons, a health care proxy is generally a much better way of giving advanced directives about your health care than communicating your preferences in writing.

Helpful Resources

The resources I most highly recommend regarding advanced directives and end-of-life decisions in general are:

1. “Now and at the Hour of Our Death: Catholic Guidance for End-of-Life Decision Making,” which includes an excellent video as well as state-by-state resources, and can be found at catholicendoflife.org

2. “A Catholic Guide of End-of-Life Decisions,” which can be ordered or printed from ncbcenter.org