MANY PEOPLE TODAY fear that their lives will be unreasonably prolonged in a way that will add to their suffering both physically and emotionally, in the most crucial moments of their lives – the end. Having seen the long and painful dying of others and the futility of using life-support systems, more and more people today are concerned about their freedom to exercise their basic rights in protecting themselves from being over-treated and possibly being depersonalised in the process.

In a free society, the principle of self-determination is often invoked by an individual to seek or not to seek certain medical procedures or treatment. Everyone has the right to be told about his medical condition, the proposed treatment, the risks of having or not having treatment. This information enables a patient to make informed decisions about accepting or not accepting certain treatments recommended by the doctors.

A question arises when an adult patient needs medical treatment but is unable to give consent or even to make known to others what medical treatment he or she wants or does not want. When a patient becomes incompetent and is unable to communicate his or her wishes about certain medical procedures, his or her rights
may be at risk. Others (some with vested interests) will be making these decisions for them, perhaps without knowing what the patients want. An Advance Medical Directive (AMD) seeks to protect the right of a person to want or to refuse medical treatment in the event he or she loses the ability to make decisions.

Documents such as AMD, Advance Medical Documents or Living Wills basically serve the same function. They are documents stating a person’s preferences in advance concerning treatment or non-treatment in the event when a person is no longer competent to make a decision. Living Will has been notoriously linked to euthanasia. Countries that legalised living wills eventually went on to allow a person to request for euthanasia. AMD is broader and it contains a person’s preferences concerning certain types of medical treatment, appointing a person to be the proxy decision maker or containing certain other instructions for doctors and caregivers.
Whether it is a Living Will or AMD, there should not be any request for euthanasia as this is synonymous with assisted suicide.

An AMD is ethically permissible provided there is no request for euthanasia. The United States Bishops’ Conference has encouraged Catholics to use such documents to exercise their stewardship over their own lives. Although it is ethically permissible for one to sign such documents, these documents do not solve all problems. There is always the issue of the manner in which these documents can be revoked. Families may also challenge doctors over their decision to forgo life-sustaining systems based on an AMD that does not reflect the true intention of the patient. Yale Kamisar, Professor of Criminal Law at the University of Chicago and others call such documents, legal abominations.

Changes in medical practices and in our own preferences may result in such directives becoming redundant and even counter-productive. No one can foresee all the circumstances in which these directives may have to be applied. From the time an AMD is written till the time it is being invoked, what is medically, financially, emotionally and physically extraordinary may become something very ordinary. This begs the question of the violation of the principle of informed consent. So there is the real danger of an AMD not reflecting the true intention of a person. Bishop Walter Sullivan of Richmond, London in his pastoral letter "Death with Dignity: Ministry not Legislation" says, "The concept of Living Will has raised a serious issue of whether a person is capable of real informed consent to such a document. The question is, "How do I determine far in advance of a terminal illness, my feelings about death?’"

AMD does serve a purpose. It should be used by patients as a means of providing family members and doctors with certain values and information to make certain decisions. It can also name a reliable and trusted person to be the proxy decision maker. However such documents should not be given legal status to avoid endless lawsuits. Although such documents in themselves are not wrong, they do not solve the problems of decision-making and they may even in some cases lead to a disrespect for human life. Many people find the conventional method of consultation between the family members and doctors sufficient.- By Father James Yeo
Singaporeans are being encouraged to prepare an Advance Medical Directive (AMD). What is it? What should we do? Here, moral theologian Father James Yeo explains what an AMD is and advises potential AMD makers and caregivers about Catholic Church teaching on this end of life issue. In brief, he says:

Although an AMD is ethically permissible, it should not contain any request for euthanasia. Assisted suicide is morally wrong.

An AMD should be as broad as possible. It should indicate one’s values concerning life and death. It may also indicate one’s preference or abhorrence towards certain medical treatment based on personal reasons or on one’s religion, race or culture.

As an alternative to making too many decisions in advance, one can also state clearly one’s surrogate, a living person who can make health care decisions in real time on our behalf if we become incompetent. This health care proxy must be someone whom we trust, who cares deeply about us, who loves us and is able to make decisions in accord with our known wishes and with our best medical and spiritual interests in mind. Some bishops have recommended this course of action.


CATHOLICS WHO ARE contemplating making an Advance Medical Directive or those who are healthcare proxies should be familiar with the teachings of the Catholic Church to help safeguard the sanctity of human life and the dignity of the human person.

Below are the central teachings that can guide us on this issue:


Intentional euthanasia, whatever its form or motives, is murder. It is gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. (Catechism of the Catholic Church no. 2324)


Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. (Catechism of the Catholic Church no. 2278)


Euthanasia must be distinguished from the decision to forego so-called ‘aggressive medical treatment’, in other words, medical procedures which no longer correspond to the real situation of the patient, either because they are by now disproportionate to any expected results or because they impose an excessive burden on the patient and his family. In such situations, when death is clearly imminent and inevitable, one can in conscience "refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted". (Pope John Paul II, Evangelium Vitae)


When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decisions to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted. In such circumstances the doctor has no reason to reproach himself with failing to help the person in danger. (Congregation for the Doctrine of the Faith, Declaration on Euthanasia)


One must always provide ordinary care (including artificial nutrition and hydration), palliative treatment, especially the proper therapy for pain, in a dialogue with the patient which keeps him informed. (Pontifical Academy for Life, Respect for the Dignity for the Dying)


Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable. (Catechism of the Catholic Church no. 2279)

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