Markkula Center of Applied Ethics

Be Not Afraid: Catholic Views on Advanced Care Planning

By Miriam Schulman

Whatever you think about the health care reform proposals now before Congress, it's a shame that advance care planning, which might have provided common ground between the parties, became so contentious that it is no longer being considered as part of the final package.

The proposal would have paid for doctors to counsel patients about planning for end-of-life decisions. Such planning-writing living wills, designating surrogate decision makers-is not only acceptable but encouraged by the Church.

Sarah Palin dubbed these advance care planning sessions "death panels," warning that Democratic bureaucrats would decide the fate of the aged and disabled, a characterization that even her Republican colleague Johnny Isakson called "nuts." In fact, advance care planning is the exact opposite of allowing the government to decide your fate.

It involves talking with medical care providers and your own family about what you would like in the event that you cannot express your own wishes. This might involve situations when you were permanently incapacitated, but it might also pertain to situations when you were temporarily unable to make your wishes known, such as during surgery.

Rev. Gerald Coleman, SS, now vice president for corporate ethics for the Daughters of Charity Health Care System, told that everyone should have a durable power of attorney for health chare, which designates a person to make medical decisions for you if you are unable to do so.

Some religious orders encourage members to complete this document. Sr. Joan Marie Steadman, associate director of health care ethics at the Markkula Center for Applied Ethics and former member of the leadership team for Sisters of the Holy Cross, said that her order asks members to discuss their health care goals and fill out a durable power of attorney for health care.

The result, according to a recent article in the New York Times, can look something like the advance care consultations provided for in the health care reform process. In the case of the Sisters of St. Joseph, the nuns consult with geriatrician Robert C. McCann about the goals of their care long before they face a crisis. That's one reason, according to McCann, that "they have better deaths than any I've ever seen."

Many religious and clergy welcome the opportunity to plan. Rev. Anthony Mancuso, a visiting scholar at the Markkula Center for Applied Ethics at Santa Clara University, sees his own advance care planning as an important way to "model behavior" for others who are struggling with end-of-life issues. He has often shared his various advance care documents with parishioners.

Monsignor Charles Fahey, chairman of the board of the National Council on Aging, told the Associated Press, ""We have to make decisions that are deliberative about our health care at every moment…. What I have said is that if I cannot say another prayer, if I cannot give or get another hug, and if I cannot have another martini - then let me go."

Miriam Schulman is the director of communications for the Markkula Center for Applied Ethics at Santa Clara University.

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