Catholic Health Australia releases new Advance Care Plan
The previous issue of The Nathaniel Report, number 42, included The Nathaniel Centre’s submission to the National Ethics Advisory Committee on the ethical challenges in advance care planning. In that submission we emphasised the need for a ‘process’ that emphasised the ongoing nature of end-of-life planning rather than a narrower approach that focussed largely on the completion of a written ‘plan’. We also highlighted the importance of people reflecting on decisions about care and treatment at the end of life before they become chronically ill.
Some may imagine that the important decisions about end of life treatment are largely ‘technical’ ones requiring the specialist knowledge and advice of the medical profession. However, while the input of health practitioners provides a necessary and invaluable contribution, there are also issues of a spiritual, relational, social, cultural, emotional and psychological nature that are part of end-of-life planning. In particular, it is advisable to include those people who will be most deeply affected and who are likely to know us best – our family, whanau and aiga as well as significant friends.
The process of advance care planning can also be a good time to think about our willingness to become an organ donor.
In response torequests about advance care planning, Catholic Health Australiahas recently released two guides; one for people considering their future health care needs, and another for health care professionals. The guides are described as being consistent with Catholic principles as well as with good secular ethics. The documents have been approved by the Committee for Doctrine and Morals of the Australian Catholic Bishops' Conference.
The guide for people considering their future health care provides advice on a range of end-of-life issues. Because illness, disease and other life events are unpredictable, the document stipulates that it is best to provide general guidance about future medical treatment rather than specific directives. It also promotes the idea that the ‘planning’ take the form of an on-going conversation with family, friends and health care professionals.
The material features a discussion about choosing a representative in the event a person becomes unable to make decisions for themselves, as well as ideas for how to go about advising that person. The document underscores the responsibility we all have to protect and sustain life and details when treatment might be refused. It provides a good concise summary of the ethics concerning treatment which is futile and ‘overly burdensome’, what the Catholic tradition often refers to as ‘extraordinary’ or ‘disproportionate’. Treatments are burdensome when they cause distress and suffering for a person, cause difficulties for the person or their family (or the community) or are costly to obtain or provide. Persons are encouraged to clarify the burdens they would find acceptable.
Critically, the document notes that in light of the continuing debates over euthanasia and the withdrawal of medical treatment, it is important for a person to state explicitly that they do want life-sustaining treatment that is reasonable to be provided unless it becomes futile or is overly burdensome. The provision of food and water is part of the normal obligation to care for a person, even when a tube is required, so long as the food nourishes and /or alleviates suffering. The risk of choking, the failure to digest food, or the discomfort of a tube are all reasons which may make the use of tube feeding overly burdensome.
Finally the document provides ‘a model statement for future health care’, which can be used as it is or to begin a discussion about end-of-life planning with a person’s designated representative/s.
The document has been designed in a way that makes it easy to follow and it is appropriate for persons receiving care in any facility. While written with a Catholic audience in mind, it is equally suitable for persons of all faiths or none.
There is also a New Zealand website that provides advice and suggestions for starting up conversations about advance care planning: http://www.advancecareplanning.org.nz/
The New Zealand Advance Care Planning Guide, as well as providing guidance for planning advance care, provides information about your rights as a patient and the legal issues as they exist in New Zealand. http://www.advancecareplanning.org.nz/assets/Advance_care_planning_guide.pdf