Bishops urge against use of POLST, living willsRead Time 4 min

Wisconsin’s Roman Catholic bishops issued a warning against the use of POLST, Physician (or Provider) Orders for Life-Sustaining Treatment, in a statement issued Wednesday, July 25.

In “Upholding the Dignity of Human Life,” the bishops wrote that the use of POLST has grave implications for the dignity of human life and they “encourage all Catholics to avoid using all such documents, programs and materials.”

“The POLST form should not be regarded as the standard model for designating treatment preferences,” read the statement signed by Milwaukee Archbishop Jerome E. Listecki, Madison Bishop Robert C. Morlino, Green Bay Bishop David L. Ricken, La Crosse Bishop William P. Callahan and Superior Bishop Peter F. Christensen.

Upon issuance of the pastoral letter, Archbishop Listecki told your Catholic Herald, “This is an important issue.  As a church we are concerned about the dignity of the human person at every stage of life – from conception to natural death.”

According to Kim Wadas, associate director, education and health care, of the Wisconsin Catholic Conference, the public policy voice for the state’s bishops, the use of POLST forms is not new. In fact, in Wisconsin, considered the birthplace of the POLST form, use began in 1990 in the western part of the state in the Gunderson Lutheran Health System, according to Wadas, who said that its use is increasing in various areas around the state, including Kenosha, La Crosse and the Fox Valley. Its use is also increasing in nursing facilities, she noted.

Because use is on the rise and because increasingly Catholics are questioning the morality of this end-of-life document, Wadas said the bishops felt it was time to address the question.

A major concern regarding the form, according to a press release issued by the WCC, 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.”

“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

The bishops also questioned the design of the form – typically two pages, according to Wadas – and expressed concern that the current form being used in Wisconsin lacks “a patient signature acknowledging that the form truly represents a person’s choices.”

“It has some serious deficits when it comes to safeguarding human dignity, said Wadas in a telephone interview with your Catholic Herald , ”and the biggest is it does not provide a patient signature,” indicating it truly represents the patient’s wishes.

The bishops noted it also lacks a conscience clause that protects facilities or practitioners, which cannot follow a POLST treatment order due to the institution’s or person’s moral, ethical or medical concerns.

They also expressed concern about documents referred to as “living wills,” suggesting they “bear a risk similar to POLST in that they do not take into account the varying circumstances that may surround a medical decision.”

“Catholics are encouraged to avoid the use of living wills,” wrote the bishops.

While they are not in favor of the POLST form or living wills, they encourage “all persons to use a power of attorney for health care” and recommended a “good durable power of attorney for health care document may be obtained from the Patients Rights Council, www.patientsrightscouncil.org.”

This approach is preferable, said Wadas, because it allows the patient to designate a trusted person to make decisions on his or her behalf, in accordance with the patient’s wishes.

“The key factor is people will have had conversations about end of life (issues) and have made it known to the decision makers what their feelings would be,” she said, adding that oftentimes these decision makers are family members who, as issues arise, can act in accordance with the patient’s views.

“For those who are age 18 or older, completing this document allows you to appoint a trusted person to make health care decisions on your behalf if a situation arises in which you cannot make these decisions for yourself,” wrote the bishops. “It is important to discuss your wishes and Catholic teaching with the person whom you appoint and to choose someone who will make health care decisions based on these principles.”

When determining whether it is morally permissible to withhold or discontinue medical treatment, the bishops quoted from the Catechism of the Catholic Church:

“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.” (CCC #2278)

The Wisconsin bishops clarified that as a general norm, food and water should always be provided, even if delivered by artificial means. Quoting from the U.S. Conference of Catholic Bishops’ “Ethical and Religious Directives for Catholic Health Care Services,” the state’s bishops wrote that artificial nutrition and hydration are “‘morally optional when they cannot reasonably be expected to prolong life or when they would be ‘excessively burdensome for the patient or (would) cause significant discomfort….’”

The bishops concluded, “… We encourage all Catholics to plan for the future in a way that fully respects our dignity and faith. In doing so, we bear witness to our greatest treasure – the inestimable gift of life from the moment of conception to natural death.”