Q: I have two questions on the Catholic faith in connection with AMD (Advance Medical Directive) and ACP (Advance Care Planning):
1) Does signing an AMD goes against Catholic teaching?
I have signed that document a few years ago because I do not want my life prolonged in the case of terminal disease with no hope of cure. But one of my Catholic friends says that signing an AMD may go against Catholic teaching. Therefore she hesitated to sign it.
2) Does signing an ACP go against Catholic teaching if I state in that document that in case of terminal disease with no hope of cure, I do not wish to be resuscitated, nor do I want to be intubated and attached to a ventilator?
As a Catholic I do not support euthanasia. I just wish to die naturally without any medical intervention which would only prolong my suffering before dying. But I do accept palliative therapy. – Oei Khoen Hwa, Singapore
This is a very pertinent question, especially when we are living in a time where debilitating illnesses are becoming very common. Many of these may require treatments and/or procedures which are not only financially straining, but also sometimes disproportionate to the expected results. Further complicating the situation may be the fact that some of these medical procedures may not actually correspond to the situation that the patient is experiencing.
The basic drive for one to sign an AMD comes from the principle of self-determination where one is fully in charge of one’s life. But to attain this end requires also that one is fully informed of all the risks involved in any medical treatment and procedure.
This directive comes into effect only when the patient himself/herself is unable to give consent or to make known to others his or her wants and needs, and when death is imminent and extraordinary life sustaining measures are used.
Because this directive has to be signed before one actually gets sick and requires such treatments, it is simply not possible to pre-empt all the possible scenarios that one could face, especially when some serious illnesses only show up a long time after the AMD is signed.
What has to be made clear is that one does not make any request for euthanasia when signing the AMD. Perhaps what is more pressing is the need to make it clear that while signing these directives can give patients and caregivers some information to guide their decisions, they do not solve all the issues and problems that will inevitably ensue.
The same considerations and conditions would apply to the signing of an ACP as well. But what needs to be emphasised is that individuals who intend to sign such directives should make sure that they talk to their family, loved ones, doctors, caregivers and pastors about the care and treatment that they would like to have if they reach a point in their lives when they can no longer speak for themselves.
Many may find this a very difficult conversation to have, and to sign this without going through that very important step could end up clouding the issue rather than making it easier. It is not uncommon to have a scenario where even doctors differ in their opinions on whether death is imminent. In these cases, having an AMD may serve to give the doctors a general guideline to know the patient’s intent.
A good explanation from a Dominican website (http://opcentral.org/resources/2014/09/05/the-catholic-tradition-on-forgoing-life-support/) can give some further insights.
One can also gain further clarity by referring to Evangelium Vitae (64-67), an encyclical written by Pope St John Paul II, which expresses the position of the Catholic Church in matters of the value and inviolability of human life. In it, he says that when one forgoes extraordinary or disproportionate means at such times where death is imminent, it is not euthanasia, but rather the acceptance of the human condition in the face of death.
It is fitting that when dealing with issues that make one think of “quality of life”, we also at the same time consider what the Church teaches about redemptive suffering. A wrong or unhealthy understanding of this term can end up with Catholics thinking that even when they are terminally ill, they must accept all aggressive treatments so that they can suffer like Jesus. This should not be the case.
Redemptive suffering doesn’t mean that one should subject oneself to all kinds of extraordinary treatment. It doesn’t mean that a patient in such a condition who chooses to accept analgesia (pain blocking medication) is steering away from participating in the sufferings of Christ.
Christians with a healthy regard to suffering must not “run to the Cross” nor feel any guilt if they are not taking suffering well like Jesus. Perhaps what needs to be inculcated throughout our lives is that if we find ourselves avoiding all forms of suffering in our younger and healthy years, we may inoculate ourselves from meaningfully participating in the redemptive suffering of Christ on Calvary when these situations present themselves to us later in life.
Fr Luke Fong