Making Health Care Decisions: A Catholic Guide

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Lastly, the Directives render it impossible to utilize new technologies that employ embryonic stem cells for both research and potential treatment.

National Healthcare Decisions Day

A surprising application of the Directives involves religious health systems as landlords. It is not unusual for a hospital to own a medical office building; less known is that the Directives can be incorporated into leases.


A medical group in Santa Rosa, California, reported that its lease required providers to "conduct their activities on the premises in accordance with the ethical and moral precepts and policies of [the] landlord including the Ethical and Religious Directives for Catholic Health Facilities. The Directives often come into direct conflict with medical guidelines because they are based on religious beliefs, not on scientific research, medical trials, or health outcomes.

Although it is entirely appropriate for individual patients to decide the role that religion will play in their personal healthcare choices, it is not appropriate for corporate healthcare providers to impose these beliefs above sound medical decision making. Health- and medical-related associations such as the American Public Health Association and the American Medical Association AMA have registered concern that mergers and affiliations with religious hospitals present serious obstacles to health options.

As a result of these restrictions, women's health services have become marginalized and fragmented with potential serious health consequences. For example, the American College of Obstetricians and Gynecologists ACOG recognizes that, unless contraindicated, an appropriate time to provide voluntary sterilizations is immediately after labor and delivery. Religious prohibition of sterilizations, however, may subject women to an unnecessary second procedure at a different facility, with attendant risk of infection, side effects of anesthesia, costs, and risk of additional pregnancies until the procedure is completed.


This assumes that another accessible facility is available and that the second procedure is affordable and can be scheduled in a timely manner. A small percentage of abortions are provided by hospitals, generally as medical necessities. Women who are medically fragile and at risk of complications and women in more advanced pregnancies may need the medical backup systems of a hospital. But religious restrictions may subject these women to the difficulty and expense of obtaining services out of their areas, as well as expose them to health risks.

ACOG and the AMA adopted guidelines requiring emergency contraception to be offered to prevent unwanted pregnancy to women who are survivors of rape. Two-thirds of these referrals proved to be dead ends.

This issue was addressed in a California Court of Appeal case, Brownfield v. Daniel Freeman Marina Hospital; Cal. Kathleen Brownfield was taken to the emergency room of a religiously sponsored hospital after being raped.

Legal Forms and End of Life Directives

Her suit alleged that the hospital failed to provide her with emergency contraception or to advise her that such a procedure was necessary within seventy-two hours of the rape to be effective. She sought declaratory and injunctive relief for the hospital's failure to provide information and a requirement that the hospital must either provide rape victims with information and access to contraception or discontinue treatment of rape victims.

The court found that, absent a statutory refusal clause, the patient maintains a common law right to self-determination in her treatment and this right prevails over an entity's moral or religious convictions. In addition, the court held that a rape victim may file a medical malpractice action for damages if she can allege that 1 a skilled practitioner of good standing would have provided her with information on and access to emergency contraception; 2 she would have elected such treatment if the information had been provided; and 3 damages have proximately resulted from the failure to provide her with information concerning this treatment option.

Implementation of the Directives has other health consequences. For example; women of childbearing age who require cancer treatments that could destroy their ability to produce eggs are often given the option to harvest eggs before treatment and preserve their future fertility.

These protocols are prohibited at Catholic facilities. Religiously sponsored HMOs often do not cover prohibited services or provide information, counseling, or referrals to plan members who may want or need these services. Women in Medicaid managed care plans face particular challenges. The Balanced Budget Act of allows managed care plans that refuse to provide reproductive health services on the basis of moral or religious objections to serve Medicaid patients.

A broad refusal clause allows them to opt out of "provid[ing], reimburs[ing] for, or provid[ing] coverage of, a counseling or referral service if the organization objects to the provision of such service on moral or religious grounds. Access problems also arise when nonsectarian health plans contract with sectarian hospitals and other entities that restrict access. For example, a woman desiring a tubal ligation at the time of labor and delivery may need to obtain these services separately if the hospital covered by the health plan refuses to provide them, or she may have to pay more out of pocket in copayments or other additional charges to obtain the services concurrently at an out of network hospital.

Often, consumers are unaware of these access limitations until the need for services arises and must contend with managed care gatekeepers and ideological ones as well. State legislatures now are requiring employers to provide contraceptive coverage as part of their prescription drug benefits, but many of these statutes contain refusal clauses. Interestingly, in two cases Catholic entities sued, claiming the refusal clauses are not broad enough.

Catholic Charities v. Superior Court, a California case, will soon be heard in the California Supreme Court, and a similar suit was recently filed in New York.

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An Advance Directive oftentimes does not allow for adequate informed consent because one must make a decision about a future medical condition which cannot be known in advance. When drawing up an Advance Directive, therefore, one should focus on general goals rather than on specific medical procedures.

Assigning Durable Power of Attorney is preferable to an Advance Directive because it leaves decisions in the hands of someone whom the patient has personally chosen. A proxy agent also can be more sensitive and responsive to the decision-making that is necessary for a given case. When assigning Durable Power of Attorney one should choose an agent of good moral character — someone who is known to be capable of making sound decisions under stressful circumstances. The agent should know the teachings of the Church and possess the practical wisdom to apply them to changing circumstances.

An agent, of course, must also survive the patient. A good agent makes decisions for the patient in light of what the patient would choose if able to do so.

Religious Beliefs and Healthcare Necessities: Can They Coexist?

The proxy, therefore, should be very familiar with your moral convictions and wishes. When there is an Advance Directive from you, this should be the guide. When there is not, the agent must act on the oral instruction that has been given. Sometimes, however, acting in your best interests means ignoring instructions that are obviously unwarranted or clearly immoral. No agent is bound to carry out actions that conflict with morality and the faith. While illness and other circumstances can make life very difficult, they cannot diminish the inestimable worth of each human life created by God.

Life itself is always a good, and is a quality that can never be lost. Euthanasia has been defined by St. They hold that it is more merciful to kill the suffering patient. At www. Must we endure a great deal of pain? What if I am no longer able to make medical decisions for myself?

Ordinary or proportionate means are those that in the judgment of the patient assisted by health care professionals offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community. While every proposed medical treatment is not required by the Church, overly-burdensome viz. The alternative to completing a MOLST form and possibly being undertreated is that all Catholics are highly encouraged to designate a healthcare proxy a Durable Power of Attorney who can speak on your behalf when you are no longer able to do so.

When the healthcare proxy knows your desire to live and die in conformity with Church teaching, then how you have lived and the important life-long values that have influenced your life, then he or she can more effectively determine which medical treatment offers the best chance for you to continue to live or, conversely, would impose such burden on you that it can be legitimately refused.

To download a copy of a Healthcare Proxy which is provided by the Dioceses of Massachusetts, click HERE If you would like a printed HealthCare Proxy mailed to you all on one sheet so that it cannot be separated accidentally please email aledoux worcesterdiocese. Tim Hogan on June 14, Celebrate Priesthood! Andrew St.