Catholic Advanced Health Care Directives for the State of California

An “Advance Health Care Directive” lets your physician, family and friends know your health care preferences, including the types of special treatments you want at the end of life, your desire for diagnostic testing, surgical procedures, cardiopulmonary resuscitation and organ donation.

By considering your options early, you can ensure the quality of life that is important to you and avoid having your family “guess” your wishes or having to make critical medical care decisions for you under stress or in emotional turmoil.

Under state law, you have a legal right to express your health care wishes and to have them considered in situations when you are unable to make these decisions yourself. Use this form to notify your loved ones of your wishes should you be unable to make your own medical decisions.

Information on and copies of the Catholic Advanced Health Care Directive available on the Catholic Archdiocese of Los Angeles web page: 

Advance Health Care Directive (ENG)
Advance Health Care Directive (ESP)

This is the only legal Catholic Advanced Health Care Directive approved for the State of California and approved by the California Conference of Catholic Bishops. Click here for a defintions sheet that will help you better understand the document. 

“Ethical and Religious Directives for Catholic Health Care Services” (Sixth Edition) and additional Church documents and guidance can be found on the website of the USCCB: http://www.usccb.org/about/doctrine/ethical-and-religious-directives/

Glossary of Terms

Watch for other helpful information regarding end of life issues in the near future.

Palliative Care

Palliative care is an expression of the truly human attitude of taking care of one another, especially of those who suffer. It is a testimony that the human person is always precious, even if marked by illness and old age.

Palliative care is an expression of the truly human attitude of taking care of one another, especially of those who suffer. It is a testimony that the human person is always precious, even if marked by illness and old age. Indeed, the person, under any circumstances, is an asset to him/herself and to others and is loved by God. This is why, when their life becomes very fragile and the end of their earthly existence approaches, we feel the responsibility to assist and accompany them in the best way.

The objective of palliative care is to alleviate suffering in the final stages of illness and at the same time to ensure the patient appropriate human accompaniment (cf. Encyclical Evangelium Vitae, n. 65).

Palliative care accomplishes something equally important: it values the person. I exhort all those who, in various ways, are involved in the field of palliative care, to practice this task keeping the spirit of service intact and remembering that all medical knowledge is truly science, in its noblest significance, only if used as aid in view of the good of man, a good which is never accomplished “against” the life and dignity of man.

From Address of His Holiness Pope Francis to Participants in the Plenary of the Pontifical Academy for Life, Clementine Hall, Thursday, 5 March 2015 

Hospice

Ensuring the best care at the very end of life. 

“The Catholic health care ministry faces the reality of death with the confidence of faith. In the face of death –for many, a time when hope seems lost – the church witnesses to her belief that God has created each person for eternal life…The truth that life is a precious gift from God has profound implications for the question of stewardship over human life. We are not the owners of our lives and, hence, do not have absolute power over life. We have a duty to preserve our life and to use it for the glory of God, but the duty to preserve life is not absolute…” 

Ethical and Religious Directives Part Five, Introduction, p 29-30
 

“You matter because you are you. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but to live until you die.”

Dame Cicely Saunders, founder of the Modern Hospice Movement  

Supporting Yourself

The stress on caregivers can be enormous. Make sure you find healthy ways to care for yourself. 
 

Come to me, all you who labor and are burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am meek and humble of heart; and you will find rest for your selves. For my yoke is easy, and my burden light.   Matthew 11:28-30 

Healer of souls and comforter of the weary, help to lighten the burden of families who are caring for their sick loved ones. 

Accompany them on their journey and ease their anxiety and fears. Surround them with the love and strength of others, so they may experience the healing presence of the communion of saints. We ask this through the intercession of Our Lady of Lourdes and in the name of your Son, Jesus and the Holy Spirit, now and forever. AMEN. 

Catholic Health Association of the United States  

Prayers for the Caregiver 


 

Supporting Patients

As a caregiver, you are not alone. Others are there to help. 
 

To heal is to do God’s holy work.  To soothe pain, to prevent grief, to wipe away a tear becomes the supreme privilege of anyone who must come in contact with the helpless, poor, and sick in body and spirit.  The alleviation of physical pain is often beyond our control but alleviation of psychological anguish is something that all of us is capable of providing.   Rabbi Shalom Stern, “When Words Fail,” Jason Aronson Inc. – 1999  

Grief Support

Through death we are born into a new life, but facing the reality of a loved one no longer physically with us takes time and support. 
 

Because of Christ, Christian death has a positive meaning: "For to me to live is Christ, and to die is gain.⁵⁷⁶  The saying is sure: if we have died with him, we will also live with him.⁵⁷⁷  What is essentially new about Christian death is this: through Baptism, the Christian has already "died with Christ" sacramentally, in order to live a new life; and if we die in Christ's grace, physical death completes this "dying with Christ" and so completes our incorporation into him in his redeeming act:
 

It is better for me to die in Christ Jesus than to reign over the ends of the earth. Him it is I seek - who died for us. Him it is I desire - who rose for us. I am on the point of giving birth. . . . Let me receive pure light; when I shall have arrived there, then shall I be a man. ⁵⁷⁸

In death, God calls man to himself. Therefore the Christian can experience a desire for death like St. Paul's: "My desire is to depart and be with Christ.”⁵⁷⁹ He can transform his own death into an act of obedience and love towards the Father, after the example of Christ:⁵⁸⁰

• My earthly desire has been crucified;…there is living water in me, water that murmurs and says within me: Come to the Father.⁵⁸¹
• I want to see God and, in order to see him, I must die.⁵⁸²
• I am not dying; I am entering life.⁵⁸³

The Christian vision of death receives privileged expression in the liturgy of the Church:⁵⁸⁴

Lord, for your faithful people life is changed, not ended. When the body of our earthly dwelling lies in death we gain an everlasting dwelling place in heaven.⁵⁸⁵

576 - Phil 1:21.
577 2 - Tim 2:11.
578 - St. Ignatius of Antioch, Ad Rom.,6,1-2:Apostolic Fathers,II/2,217-220.
579 - Phil 1:23.
580 - Cf. Lk 23:46.
581 - St. Ignatius of Antioch, Ad Rom.,6,1-2:Apostolic Fathers,II/2,223-224.
582 - St. Teresa of Avila, Life, chap. 1.
583 - St. Therese of Lisieux, The Last Conversations.
584 - Cf. 1 Thess 4:13-14.
585 - Roman Missal, Preface of Christian Death I.

Ethical and Religious Directives

The Bishops of the United States have provided guidance for Catholic health care institutions in ethical decision making. 

Ethical and Religious Directives - The Ethical and Religious Directives (ERD) are guidance provided by the U.S. Conference of Catholic Bishops (USCCB) to Catholic health ministries throughout the nation. “The Directives have been refined through an extensive process of consultation with bishops, theologians, sponsors, administrators, physicians, and other health care providers,” according to the introduction. “While providing standards and guidance, the Directives do not cover in detail all of the complex issues that confront Catholic health care today.” In making any decision about the end-of-life the ERDs should be combined with prayerful discernment, careful information gathering and thorough consultation with spiritual and medical experts.

“While every person is obliged to use ordinary means to preserve his or her health, no person should be obliged to submit to a health care procedure that the person has judged, with a free and informed conscience, not to provide reasonable hope of benefit without imposing excessive risks and burdens on the patient or excessive expense to family or community.” #32

“A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.” #56

 

Nutrition and Hydration

Guidance from the Catholic Church

Pope Francis -  "….it has also become possible nowadays to extend life by means that were inconceivable in the past.  Surgery and other medical interventions have become ever more effective, but they are not always beneficial: they can sustain, or even replace, failing vital functions, but that is not the same as promoting health.  Greater wisdom is called for today, because of the temptation to insist on treatments that have powerful effects on the body, yet at times do not serve the integral good of the person.” Message to European regional meeting, World Medical Association, November 7, 2017

"In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally…The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching."  ERD, 58 and 59, p 31 A.

For the dying patient - Medically assisted nutrition and hydration become 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 physical discomfort, for example resulting from complications in the use of the means employed. For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrient and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort. ERD, 58, p 31 “...

[W]e should not assume that all or most decisions to withhold or withdraw medically assisted nutrition and hydration are attempts to cause death. To be sure, any patient will die if all nutrition and hydration are withheld. But sometimes other causes are at work—the patient may be imminently dying…from an already existing terminal condition.” Nutrition and Hydration: Moral and Pastoral Reflections, USCCB, 1992 B.

For the patient in a “persistent vegetative state” - This obligation [to provide food and water] extends to patients in chronic and presumably irreversible conditions (e.g., the “persistent vegetative state”) who can reasonably be expected to live indefinitely if given such care. ." ERD, 58, p 31

"In particular, I would want to emphasize that the administration of water and food, even when it is provided by artificial means, always represents a natural means of preserving life, not a medical intervention. Its use is therefore considered to be, according to the principle, proportionate, ordinary and as such, morally obligatory, in the degree to which and until it has been demonstrated to attain its own proper finality, which in this instance consists in providing nutrition to the patient and alleviating their suffering.” Pope John Paul II on Life-Sustaining Treatment and the Vegetative State (March 20, 2004)

 

Pas or Euthanasia

Physician-assisted suicide and euthanasia attack our inherent dignity and worth. 

Gaudium et Spes - “Furthermore, whatever is opposed to life itself, such as any type of murder, genocide, abortion, euthanasia or willful self-destruction, whatever violates the integrity of the human person, such as mutilation, torments inflicted on body or mind, attempts to coerce the will itself; whatever insults human dignity, such as subhuman living conditions, arbitrary imprisonment, deportation, slavery, prostitution, the selling of women and children; as well as disgraceful working conditions, where men are treated as mere tools for profit, rather than as free and responsible persons; all these things and others of their like are infamies indeed. They poison human society, but they do more harm to those who practice them than those who suffer from the injury. Moreover, they are supreme dishonor to the Creator.” [27]

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