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August 26, 2012

New kind of order could help clarify end-of-life wishes But Wis. bishops concerned about euthanasia threat

By Michelle Martin


Catholics have long been advised to make their wishes regarding end-of-life care clear to their loved ones by establishing a durable health care power of attorney, which delegates the authority to make medical decisions when the patient cannot, and a written advance directive to spell out what kind of measures the patient would want.

A new kind of document — “physician orders for life-sustaining treatments” — now is being used in some states, and Father William Grogan, the archdiocesan vicar for health care, and chair of the archdiocesan Bioethics Committee, said he supports efforts to develop a POLST form in Illinois, despite opposition to use of the form in Wisconsin by that state’s Catholic bishops.

Unlike advance directives or durable powers of attorney, Grogan explained, POLST orders are part of a patient’s medical chart, easily accessible to caregivers. They travel with patients from one medical facility to another.

“When you go in for a surgery, by the time you get there, the doctor has already written several orders for you,” Grogan said. “So when someone comes to take your blood, or someone comes to take you for an X-ray, they are acting on those orders. This [POLST] provides the doctor with a standing set of orders for end-of-life care.”

Unlike an advance directive, the POLST form would not address every possibility; it would address only those that are likely to arise in the patient’s situation. For example, a patient who is terminally ill with cancer would have a different set of orders than one who had suffered a stroke or a heart attack.

While there is no active POLST program in Illinois, health care providers, including Catholic hospitals, are trying to develop one, Grogan said. Such orders are allowed under an Illinois law that went into effect Jan. 1.

The Wisconsin bishops came out against the use of POLST orders in July, saying they should not be seen as the standard model for designating treatment preferences.

A major concern, according to a July 25 press release issued by the Wisconsin Catholic Conference, is the “form presents options for treatments as if they were morally neutral. In fact, they are not. Because we cannot predict the future, it is difficult to determine in advance whether specific medical treatments, from an ethical perspective, are absolutely necessary or optional.”

Grogan agreed that not all treatment options are morally neutral, but said that POLST can be used to make sure that patients get the care they want, and that Catholic patients can use them to make sure that their treatment is in accordance with Catholic teaching.

In general, the church teaches that all ordinary means must be taken to preserve human life. Extraordinary means — procedures or treatments that are unduly burdensome because they would cause too much suffering or have little possibility of benefitting the patient — need not be taken.

Providing nutrition and hydration, through a feeding tube if need be, is presumed to be ordinary care under most circumstances.

The Wisconsin bishops disagree about the utility of POLST orders.

“A POLST oversimplifies these decisions,” wrote the bishops, “and bears the real risk that an indication may be made on it to withhold a treatment that, in particular circumstances, might be an act of euthanasia. Despite the possible benefits of these documents, this risk is too grave to be acceptable,” they wrote in “Upholding the Dignity of Human Life.”

Grogan said that the concerns about POLST orders are overblown.

“Some very concerned pro-life people believe this is a vehicle for active euthanasia,” he said. “I think this is really a misrepresentation. You have to look at how these can be tailored in each situation. There’s supposed to be a conversation between doctor and patient. … The alternative is to have no idea what the person’s wishes are. They may be forced into additional care when they have basically died.”