by Marc and Julie Anderson
KANSAS CITY — A document years in the making was recently released by the Archdiocese of Kansas City in Kansas. It is called the “Catholic Guide for End of Life and Establishing Advance Directives.”
It’s aimed at helping Catholics navigate the maze of legal, medical and spiritual questions that might arise as part of the complex decisions that individuals face in times of serious illness or as death approaches.
Six years ago, in response to questions from the Catholic medical community, Archbishop Joseph F. Naumann formed the archdiocesan Ethics Advisory Council — a panel of medical doctors, psychologists, bioethicists, attorneys, priests and archdiocesan staff — with the purpose of advising him on ethical issues Catholics face in today’s world, particularly in health care.
At that time, a new document known as TPOPP was being circulated in the Kansas City metro area. Several Catholic doctors, nurses and priests, as well as pro-life groups, were concerned about the form’s structure and language, as well as the potential for Catholic sensibilities to be ignored in times of grave illness.
TPOPP, short for Transportable Physician Orders for Patient Preferences, is usually printed on a pink form and contains several sections in which people simply check off their wishes. For example, in a section about feeding and hydration, the expectation is people will check one of three boxes indicating whether they desire medically assisted feeding and hydration.
After completion, the form becomes “transportable” and “follows” a person — to a hospital, rehabilitation facility or nursing home. In fact, it functions like an advance directive or living will.
As chair of the council, Dr. Patrick Herrick, a board-certified family medicine specialist in Olathe, said the challenge with many secular forms such as TPOPP is that decisions surrounding illness and life’s end can be extremely complicated.
“There’s a lot that goes into end-of-life decisions. A lot of things can’t be anticipated,” he said. “How many of us would make a grocery list . . . years in advance? And this is a bigger issue.”
Vicar general Father Gary Pennings agreed.
“There’s a lot of confusion about forms. A lot of the secular forms that are used don’t necessarily respect Catholic sensitivities about end-of-life decisions,” he said.
In response, the council decided to produce a comprehensive guide for archdiocesan priests and laity as a resource for conversations about the complex issues surrounding serious illness and end of life.
“The ethics council members thought it would be good if there was a guide for parishioners, for Catholics, that was kind of adapted for our diocese,” said Father Pennings.
Drawing upon previously published guides, Father Pennings and Herrick said the council spent countless hours researching the work of other dioceses, statements made by the U.S. Conference of Catholic Bishops, and documents published by the Vatican and organizations such as National Right to Life, the Catholic Medical Association and the National Catholic Bioethics Center.
The resulting document covers topics ranging from the elements of moral decision making and the value and dignity of human life to the question of suffering and the church’s teaching on nutrition and hydration. It also addresses euthanasia and assisted suicide.
Additionally, the guide discusses the different forms addressed in Kansas law, including the Durable Power of Attorney for Health Care (DPOA-HC), the Do Not Resuscitate (DNR) directive and the Declaration to Withhold or Withdraw Life-Sustaining Procedures. (The TPOPP form currently does not fall under any of the three categories of directives enumerated in Kansas law.)
It also provides sample documents that align with church teaching that Catholics can copy or download for their own personal use.
Both Father Pennings and Herrick said it’s important to realize that thinking can change over time, and Herrick said he has both read of and seen in his practice people change their minds in the midst of serious illness.
Father Pennings agreed.
“The situation can change,” he said. “Your thinking can change in the midst of illness.”
Because of this, Father Pennings said, the archdiocese tries to steer people away from living wills or check-the-box-type forms. Instead, it identifies the DPOA-HC form as the preferred kind of advance directive.
“The archdiocese actually promotes having a Durable Power of Attorney for Health Care, someone that knows you, knows your religious faith and knows what your wants are, and then, they can make those decisions for you should you become incapacitated,” he said.
Although the guide provides sample forms, Father Pennings said the archdiocese still advises Catholics to consult with their parish priest and an attorney who respects the Catholic faith prior to signing forms that will become legally binding.
In the vast majority of cases, said Herrick, nutrition and hydration should be provided, even if medically assisted. Undue interruption of them can result in euthanasia by omission.
Another topic the council discussed, Herrick said, was the subject of consciousness.
“The church has said that people should not be deprived of their consciousness [without a compelling reason],” Herrick noted.
According to church teaching, the dying should be able to satisfy moral duties such as receiving the sacraments and saying goodbye to their loved ones, he said. Medications used for the sole purpose of alleviating pain sometimes result in unintended side effects that leave patients semiconscious.
“If you’re really just trying to ease pain and there’s no alternative, it’s understandable,” he said.
But the dying have a right to the love of their family, he added.
Finally, a significant portion of the guide is dedicated to a discussion of Catholic funerals and burial information.
“One of the things that the pastoral members of the council were concerned about was they’ve seen instances where the faith mattered very much to someone who had died, and for one reason or another, it was not held in the same esteem by their family,” said Herrick.
“They had seen people get deprived sometimes even of the sacraments at the end of life and even a Catholic burial,” he added. “That’s definitely received some due attention in this new document.”
That’s why, Father Pennings emphasized, even in the midst of life, it is important to give some thought to preparing for death.
“That’s what our faith calls us to do,” he said, “because that’s how we enter eternal life.”
For more information
To download and/or print a copy of the complete “Catholic Guide for End of Life and Establishing Advance Directives,” or to access individual forms to download or print, click here.
Hard copies are also available for purchase through the pro-life office. Contact Debra Niesen, archdiocesan consultant for the pro-life office, at (913) 721-1570 or by email at: dniesen @archkck.org.
Watch for a video presentation on end-of-life issues to accompany the guide in the near future on the website above.