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Physician-assisted suicide prevention

December 10, 2015
Vicki Evans

Much has happened on the assisted-suicide front. The California legislature went into an extraordinary session on health care and emerged with a bill legalizing physician assisted suicide. Gov. Jerry Brown signed the bill and a referendum campaign, supported by the bishops of California, is now in full swing to overturn the law. If the required number of signatures is collected, the law will remain on hold pending the outcome of next November’s election.

Whatever the outcome, it’s not too early to start the process of protecting yourself by preparing documents that indicate your end-of-life wishes.

Which documents are appropriate?

An Advance Health Care Directive appoints a surrogate decision maker or agent empowered to make medical decisions when you no longer can. It is essential to appoint a family member, friend or caregiver who understands your values and wishes, since one day your life may literally be in their hands. The directive might also express your general desires concerning treatment, although being too specific is discouraged given that no one can predict the future or provide for every contingency.

The Los Angeles archdiocese developed an Advance Health Care Directive based on Catholic principles, which is endorsed by the California Catholic Conference and available at http://sfarchdiocese.org/home/ministries/social-justice-life/respect-life/end-of-life-issues.

This directive summarizes Catholic teachings based on the Vatican’s “Declaration on Euthanasia.” Euthanasia, defined as the intentional ending of life by action or omission to relieve suffering, is not permitted. That includes physician assisted suicide. Medicating to control pain is not euthanasia because the intent is alleviation of severe pain, not the death of the patient. There is no obligation to pursue or continue life-sustaining treatments if risks or burdens to the patient are disproportionate to expected benefits. Failure to provide nutrition and hydration, for the purpose of ending life or accelerating death, constitutes euthanasia.

A newer document introduced in California in 2008 is Physician Orders for Life-Sustaining Treatment. POLST is a legal document that becomes binding immediately upon completion, when signed by physician and patient (or patient’s surrogate). It remains in the patient’s medical records until revoked and should be used only for individuals with an advanced or critical illness. POLST does not replace an advance directive. If there is a conflict between the two documents, the most recently signed controls – or the patient’s verbal expression of his wishes.

POLST is completed by checking off three boxes on a bright pink form:(1) attempt CPR or do not attempt; (2) as to medical interventions, provide full, selective, or only comfort-focused treatment; and (3) provide artificial nutrition on a long-term basis, trial basis, or not at all. These are morally grave choices that cannot be divorced from actual circumstances. A particular medical intervention could be obligatory or optional depending on the context. Therefore, POLST should only be completed with reference to actual medical conditions as they develop.

As a general rule, it is prudent to have an Advance Health Care Directive on file and, as particular circumstances arise, to complete POLST with respect to those circumstances.

Evans is Respect Life Coordinator for the Archdiocese of San Francisco.

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