Living wills can complicate treatment

By Msgr. Pedro Lopez-Gallo

I sometimes seem to wait in vain for somebody to come for confession as I sit and read my breviary. The sacrament of reconciliation with God is becoming more and more obsolete for many practicing Catholics. Is this a sign of spiritual tepidity or ignorance of sin?

Once in a while someone who comes does not follow the standard ritual, which starts off with "Father, forgive me, for I have sinned."

A lady once started off, "Father, is it a sin to mention in my will that I want to die as my aging parents did, with no special treatment, no tubes, no artificial means of resuscitation? I am getting old and it is time for me to go."

It was not easy for me to say yes or no. I needed more details about the treatment she was refusing, and I also wanted to know a little more about her family.

I was also aware that technology is so advanced now that to refuse certain life-saving treatments is tantamount to suicide. Today heart transplants, pace-makers, and respirators for pulmonary congestion are routine interventions.

If we consider that all Canadians, rich or poor, have access to such medical assistance, we cannot regard these as extraordinary. It is a completely different situation in third world countries which offer no social security, so that such treatment involves an enormous amount of money which poorer citizens cannot afford.

I do not like to give lectures when I am administering the sacrament of reconciliation, but in this case, I was obliged to reply as the lady was impatiently waiting for an answer.

It is in moments like these that the office of a priest is difficult to fulfil. My immediate reaction was to ask her: "Are you saying that you are looking for assisted suicide?"

She replied, indignantly: "No, Father, I never thought of that. What I want is, not to prolong my life artificially with tubes everywhere. If I give express instructions about this in my will, would they be permitted or prohibited by the Church?"

This time I answered without hesitation. "Yes, ma'am, you may write this in your will, but it would be remiss of me if I did not advise you that this would be useless, because the contents of your will can only come into force post mortem: that is, when it is read after you die, therefore the instructions would be ineffective.

"It is better that you discuss this with your family doctor and you together produce a written agreement to stop extraordinary means to prolong your life. This statement should be kept by your nearest relative."

The lady left, only to come back 10 minutes later to tell me that the matter was so complicated that she thought it best to put her life in the hands of God.

I know that today people have "living wills." These are clear written instructions that state how they wish to be treated: with all possible medical intervention, or with what limits on treatment, if they are unable to speak for themselves. This could be because of terminal illness or permanent unconsciousness as a result of illness, injury, or old age.

Living wills are designed for use in near-death situations, to remove the stress on family members and friends, and the guilt associated with these decisions.

However this can lead to havoc. Suppose you have a heart attack just as you are stepping out of your home. Your neighbour will immediately call 911 and paramedics will arrive with sirens blaring.

They will follow their established procedure: help you to breathe and transport you to emergency without waiting for your family. There the hospital staff will do their utmost to save your life, otherwise they could be sued for negligence.

Living wills can often conflict with the resuscitation efforts that the paramedics are required to follow.

Last year a law was put into effect by the state of New York which solved this problem by obliging emergency responders to use invasive treatment on a patient admitted in critical condition even if it is contrary to the wishes of the dying person and his relatives.

This is what the Hippocratic Oath is about: saving human life at all cost. Many hospitals also have a special form, called the medical order for life-sustaining treatment, which lets patients indicate whether they want intravenous fluids, medication like antibiotics, feeding and breathing tubes, etc.

In the form, which must be signed by a physician, patients can also specify if they only want "comfort" care or if they are open to trying treatments.

I must also advise that living wills should not direct doctors to engage in anything illegal, taking into consideration that euthanasia or assisted suicide is illegal in Canada and is severely condemned by the Catholic Church.