Dr. Paul Fiacco and Father Charles Vavonese | Special to the Catholic Sun
Editor’s note: This is one in a series of articles that will explain and explore the Church’s teachings on end-of-life and palliative care issues.
Dr. Paul Fiacco is the president and medical director of CNY AIM, a St. Joseph Health clinically integrated network (CIN), and the medical director of the Trinity Health Integrated Care ACO. He is also a full-time family physician at CNY Family Care in East Syracuse and a parishioner at Holy Cross Church in DeWitt.
Father Charles Vavonese is a retired priest of the Diocese of Syracuse, and was the author of “I Am the Resurrection and the Life,” a resource booklet dealing with end-of-life moral issues which is no longer available. He currently serves patients receiving palliative care as the chaplain for the St. Joseph Health Mobile Integrated Services Team. In addition, he assists on weekends at Holy Cross Church in DeWitt.
The previous article illustrated a new model for delivering palliative care into the community. Palliative care augments the traditional office-based model by providing needed health and other related care to patients with serious illness directly in their homes. These community-based programs allow patients to maintain independence as they cope with the progression of their illness and treatment. The goal is to improve the life and care of patients and their families while reducing the burdens caused by their serious illness. The success of these programs and the ability to reach more vulnerable patients in our community depends on an expanded collaboration between the Church, other faith communities, and healthcare system networks. With this collaboration, palliative care becomes a powerful antidote to euthanasia and physician-assisted suicide. Palliative care also focuses on understanding the patient’s and family’s values to help guide moral, medical, and health-related legal decisions. This article will focus on the health care legal documents that need to be considered when dealing with end-of-life issues.
There are a large number of documents that assist us with end-of-life issues; since many of them have similar names, confusion frequently occurs. To assist in clarifying the differences, we have outlined below brief explanations of the most important end-of-life documents.
Health care proxy
The health care proxy (called in some states a Durable Power of Attorney for Health Care) is the most important advance care planning document that individuals can execute. It authorizes a person you designate to make health care decisions on your behalf should you become unable to make these decisions for yourself. Designating a health care proxy is an important advance directive for Catholics because you instruct the person acting as your proxy to apply your wishes with Catholic moral principles to a medical situation. Since people can become incapacitated at any age, everyone should consider an appropriate individual and complete the health care proxy document.
Advance care directives
Advance care directives describe the set of instructions someone prepares in advance of an illness that determines his health care wishes. These individual instructions provide guidance and ethics to your health care proxy about your wishes for end-of-life decisions. These decisions include nutrition, hydration, antibiotics use, and intubation. There are many kinds of advance care planning documents; a living will is commonly used type. As with all health care decision making, key sanctity-of-life principles as taught by the Roman Catholic Church should be integrated into all advance care planning documents.
Power of attorney
A power of attorney allows you to empower another person to act on your behalf for legal and financial matters. This document does not allow the individual to make health care decisions on your behalf.
Will and testament
The fundamental purpose of a last will and testament is to outline who will receive your assets upon your death. Another important purpose of a will is to specify guardianship for your minor children. A guardian is one who takes legal responsibility for the care of your minor or incapacitated children after you are gone.
DNR and DNI orders
DNR is the acronym for a Do Not Resuscitate order; DNI is an acronym for Do Not Intubate. A DNR is the order given by you not to be resuscitated by CPR (cardiopulmonary resuscitation) so that if your heart stops or you are no longer able to breathe on your own, health care providers or bystanders will not attempt to revive you. A DNI is the specific order given by you only concerning intubation. A DNR or a DNI are considerations for end-of-life and not for healthy individuals. For elderly Catholics or those with a serious illness, considering a DNR or DNI requires weighing the benefits and burdens of CPR or intubation and if it constitutes ordinary or extraordinary care.
Organ donor card
Many parts of the human body can be donated after death with the intent to improve the quality of life for others. Our body can provide up to 50 donations of organs or tissues, including eyes, the heart, liver, skin, and others. After a death, a previously signed organ donation card gives the hospital permission to retrieve these organs for donation to other individuals in need of them.
Medical Orders for Life-Sustaining Treatment (MOLST)
Medical Orders for Life-Sustaining Treatment (MOLST) is the document used in New York State as the legal form establishing the medical orders necessary to administer or withhold treatments. These orders take effect immediately upon signing by the patient (or proxy) and the health care provider and are not conditioned upon the patient losing capacity. In other states this form may be called a POLST (Physician Orders for Life-Sustaining Treatment). The MOLST or POLST document will refer to a patient’s prior legal health care documents such as the health care proxy, advance care directives, and DNR. Some bishops conferences urge caution when filling out the MOLST form, as the document is intended for use only by those who are in the final stages of illness or frailty.
To help readers avoid confusion among the numerous end-of-life documents, this article described some of the more common documents that are used at the end-of-life. It outlines and provides an explanation of the health care proxy, advance care directive, power of attorney, last will and testament, DNR/DNI orders, organ donation card, and Medical Orders for Life Sustaining Treatment (MOLST) forms.