Some guidelines about medical decisions at the end of life

Everyone knows that death is inevitable.

Many people wisely prepare for it, including making their wills, planning their funerals, and even purchasing burial plots. That’s all good, but what about preparing for the final moments of this life? Can we prepare to have the appropriate medical care during our last days? Who will make medical decisions if you cannot make them yourself? These questions have become increasingly critical as medical science has advanced; people now live longer, and adult children often become involved in their elderly parents’ medical care. The Church provides guidance for those who must face such questions.

All persons, regardless of their medical conditions, are created in the image and likeness of God and maintain their human dignity throughout their lives, even in advanced age and sickness; thus, they have the right to basic care. Basic care includes food, water, and clean, comfortable surroundings. Patients in pain should have their pain managed to the extent possible. If food and water must be given artificially (for instance, through a feeding tube), they should be given food and water. These measures constitute basic care, not medical treatment, and should be continued as long as necessary. Food and water may be withheld only if they become burdensome to the patient (for instance, if the patient requires assistance to receive and digest them properly).

Next, we must consider medical treatment. A patient who is sick or injured should have appropriate medical treatment, but are we obligated to use every therapy available? The answer is no; we are not obligated to use every treatment. We are compelled to use proportionate means to preserve life; we are not obligated to use disproportionate means. Treatment may be proportional or disproportionate relative to the good being sought (i.e., the patient’s health and recovery), and many factors must be considered, including the patient’s condition and the nature of the sickness or injury being treated.

A proportionate treatment offers some benefit without excessive burdens; a disproportionate treatment is more burdensome than beneficial. Disproportionate treatments are optional, but proportional treatments are obligatory. To refuse disproportionate therapies is not to participate in killing a patient; instead, it is simply to accept the inevitability of death. Rarely can a treatment be judged as either proportionate or disproportionate without reference to a specific case; any proposed treatment must be assessed in consideration of the patient’s condition.

Medical providers must give their patients a true and accurate description of their conditions and the treatments they propose, and patients usually can assess them as proportionate or disproportionate; but what happens when a patient’s condition prevents them from making these decisions? Patients have the right to prepare and express their wishes, even when they are unable to make decisions for themselves. This brings us to the reason for making advance plans.

Most Catholic ethicists recommend a Durable Power of Attorney form, by which a person designates another person to make health care decisions if they are unable to do so themselves. The agent (the person designated) will speak to the medical personnel on the patient’s behalf, assess the patient’s condition and the proposed treatments, and make the decision that is in the patient's best interests. The Durable Power of Attorney form should not reject specific treatments out of hand and should give the agent the latitude necessary to make appropriate decisions. For us as Catholics, we must designate agents who share our Catholic values, especially our commitment to the sanctity of human life and our respect for the dignity of the person at all stages of life. The agent should have the strength of character to make the right decision when the time comes, and they should not hesitate to consult a priest when more guidance is needed.

Just as the guidance of the Church is helpful and comforting in times of sickness, it remains so at the end of life and even after death. The sick and the suffering are particularly close to Jesus in their trials, and Jesus will count the care and kindness we render to them as done to Himself (Mt 25:31-40). We cannot avoid suffering and death, but those who care for their loved ones can take comfort in the Church’s guidance and be at peace knowing they have done their best for them.