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CATHOLIC DECLARATION ON LIFE AND
DEATH
FLORIDA CATHOLIC CONFERENCE |
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The care and treatment of dying patients, living wills, and
advance directives concerns all of us today. Economic, legal and
technological considerations often seem to outweigh human dignity toward the
end of life.
For your convenience we provide below a form of a Catholic Declaration on
Life and Death which is deemed acceptable for Catholics, and conforms with
Florida law. Space is provided for each person to add his or her own
personal desires and/or directions.
Examples are:
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where and how care
is to be given,
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special directions
for loved ones,
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specific
information related to medical treatment and conditions.
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A woman of
childbearing age may want to add: If I should be pregnant, and that
condition is known to my physician, then every means should be taken to
preserve the life of my unborn child, including the continuation of life
prolonging procedures.
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Others may wish to
add: I hereby donate any needed organs or parts of my body, to take effect
upon my death, as an anatomical gift. This is subject to the provisions
and protections of Section 732.914, Florida Statutes, and other similar
laws.
This
Declaration provides instructions for treatment in a terminal
illness. Also included is a Designation of Health Care Surrogate,
which identifies the person to speak for the patient who cannot speak for
himself or herself, whether terminal or not. Each of these documents
should be discussed with family members and the surrogate while the signer
is competent.
Other documents are helpful in conditions that are not terminal, but involve
possible incapacity or incompetency, such as a Durable Power-of-Attorney.
Moral, legal and medical questions might well be referred to one's pastor,
attorney or physician.
This Catholic Declaration On Life and Death updates similar documents
published by the Florida Catholic Conference in 1990 and 1993.
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CATHOLIC DECLARATION ON LIFE AND DEATH
ADVANCE DIRECTIVE
(HEALTH SURROGATE DESIGNATION/LIVING WILL) OF
__________________________________________________________
(Name)
Introduction
I am executing this Catholic Declaration on Life and Death while I am of sound mind. It is intended to clarify my wishes for treatment in situations that may arise in which I am incapacitated or unable to express these wishes.
Statement of Faith
I believe that I have been created for eternal life in union with God. The truth that my life is a precious gift from God has profound implications for the question of stewardship over my life. I have a duty to preserve my life and to use it for God’s glory, but the duty to preserve my life is not absolute, for I may reject life-prolonging procedures that are insufficiently beneficial or excessively burdensome. Suicide and euthanasia are never morally acceptable options.1 If I should
become irreversibly and terminally ill, I request to be fully informed of my condition so that I can prepare myself spiritually for death and witness to my belief in Christ’s redemption.
Designation of Health Care Surrogate
In the event that I become incapacitated I designate as my surrogate for health care decisions (if no surrogate is to be appointed, please write “none” in place of “name” below):
Name: ________________________________________________________________________
Address: ______________________________________________________________________
Phones (H, W, C):_______________________________________________________________
If my surrogate is unwilling or unable to perform his or her duties or cannot be contacted, I wish to designate as my alternate surrogate (if no alternate surrogate is to be appointed, please write “none” in place of “name” below):
Name: ________________________________________________________________________
Address: ______________________________________________________________________
Phones (H, W, C):_______________________________________________________________
This directive will permit my surrogate to make health care decisions, and to provide, withhold, or withdraw consent on my behalf; to apply for public benefits to defray the cost of health care; to receive my personal health care information; and to authorize my admission to or transfer from a health care facility. It is not being made as a condition of treatment or admission to a health care facility. This document must be signed and witnessed on the other side to be valid.
1
Cf United States Conference of Catholic Bishops, Ethical & Religious Directives for Catholic Health Care Services (USCCB: Washington, DC 2001), Part Five.
The following gives guidance for carrying out my wishes at the end of life. If at any time I am incapacitated and I have a terminal condition or I have an end-stage condition, and if my attending or treating physician and another consulting physician have determined that there is no reasonable medical probability of my recovery from such condition(s), my health care surrogate (designated above, if any) will be authorized to make decisions for me in accordance with my wishes
expressed in this Declaration. If my surrogate cannot be contacted (or I have not named a surrogate), then I request and direct that each of the following be considered in making a decision for me.
That:
1. I be provided care and comfort, and that my pain be relieved;
2. No inappropriate, excessively burdensome nor disproportionate means be used to
prolong my life.
This can include medical or surgical procedures;
3. There should be a presumption in favor of providing nutrition and hydration to me,
including medically
assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens
involved to me;
4. Nothing be done with the intention of causing my death; and
5. Spiritual care be provided, including sacraments whenever possible.
Additional Instructions
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Signatures Required
It is my intention that my surrogate, family and physicians honor this declaration as the expression of my treatment wishes. I understand the full import of this declaration, and I am emotionally and mentally competent to make this declaration.
______________________________________ ______________________________________
DECLARANT Date
Last 4 Social Security Number: _____________________
______________________________________ _____________________________________
Witness Signature Witness Signature
______________________________________ _____________________________________
Printed/Typed Name Printed/Typed Name
The Health Care Surrogate cannot serve as a witness; at least one witness must not be a spouse or blood relative of the person signing.
January 1, 2005
Copies of this form are available from the Florida Catholic Conference, 201 West Park Avenue, Tallahassee, FL 32301-7715
www.flacathconf.org
DESIGNATION OF HEALTH CARE SURROGATE
of (Name)_______________________________
Should I become comatose, incompetent or otherwise mentally or physically
incapable of communication, and two physicians determine that I cannot make
my own health care decisions, then I designate as my surrogate, to make
health care decisions for me, including decisions to apply for public
benefits, authorize my admission or transfer to a health care facility, and
to initiate, continue, withhold or withdraw life prolonging procedures, the
following person:
Name) __________________________
(Street Address) _________________________________
City__________________
State ______________ Zip _______
(Phone) ______________
(Witness) __________________________
(Street Address) _________________________________
City__________________
State ______________ Zip _______
(Phone) ______________
(Witness) __________________________
(Street Address) _________________________________
City__________________
State ______________ Zip _______
(Phone) ______________
If that person is unwilling or unable to act, then as my alternate surrogate
is:
(Name) __________________________
(Street Address) _________________________________
City__________________
State ______________ Zip _______
(Phone) ______________
(Witness) __________________________
(Street Address) _________________________________
City__________________
State ______________ Zip _______
(Phone) ______________
(Witness) __________________________
(Street Address) _________________________________
City__________________
State ______________ Zip _______
(Phone) ______________
Additional directions:
Signed this _____ day of ____________ , 20 ___
(Signature)____________________________
Address) _________________________________
City__________________
State ______________ Zip _______
(Phone) ______________
The declarant is personally known to me and I believe him/her to be of sound
mind. (The witnesses cannot be the health care surrogate; only one witness
can be a spouse or relative of the signer.)
(Witness) __________________________
(Street Address) _________________________________
City__________________
State ______________ Zip _______
(Phone) ______________
(Witness) __________________________
(Street Address) _________________________________
City__________________
State ______________ Zip _______
(Phone) ______________
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Update on Changes by
Florida Catholic Conference |
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In April 1989, the Florida
Catholic Conference issued a statement on Life, Death and the Care of Dying
Patients. Portions of that statement follow.
". . . Our Judeo-Christian heritage holds that life is the gift of a
loving God, and that each human being is made in the image and likeness of
God. As Christians we also celebrate the fact that we have been redeemed by
Jesus Christ and are called to share eternal life. We see life as a sacred
trust over which we can claim stewardship, but not absolute dominion."
"Therefore the Church condemns all direct attacks on life at any of its
stages, including murder, euthanasia and willful suicide. . . ."
"These prohibitions against murder, euthanasia, suicide and assisted suicide
are based on the inherent dignity and fundamental value of each human being,
and thus cannot be rejected on grounds of political pluralism or religious
freedom."
"Prolonged illness and the agony it sometimes brings cry out for the
compassion and support of the entire community. The story of Jesus tells us
that suffering need not be useless, but can become meaningful and redemptive
through our response as we care for the sick and especially for those who
are terminally ill. Illness and intense suffering do not justify the
deliberate taking of human life, but rather call for a profound recognition
of and respect for the dignity of the patient. Such dignity is not lost
through illness because it resides in our relationship to God. Consequently
the deliberate taking of life, even with the intention of ending suffering,
is not permissible, nor is it a response worthy of a faithful steward.
Medicine that is administered to suppress pain is permissible, even though
it may have the side effect of hastening death, so long as the intention is
to ease the pain."
"Faithful stewardship over life requires us to preserve and promote it, to
take care of our own health and to seek necessary medical care from others.
This does not require that every possible remedy be used in every
circumstance."
"In 1980, the Vatican Declaration on Euthanasia stated: In the past,
moralists replied that one is never obliged to use "extraordinary" means.
This reply, which as a principle still holds good, is perhaps less clear
today, by reason of the imprecision of the term and the rapid progress made
in the treatment of sickness. Thus some people prefer to speak of
"proportionate" and "disproportionate" means. In any case, it will be
possible to make a correct judgment as to the means by studying the type of
treatment to be used, its degree of complexity or risk, its cost and the
possibilities of using it, and comparing these elements with the result that
can be expected, taking into account the state of the sick person and his or
her physical and moral resources."
"The application of this principle becomes difficult in many cases and
should be made by the patient in consultation with his or her family,
physician, and priest or minister, whenever that is possible . . ."
"A treatment is judged excessively burdensome if it is too painful, too
damaging to the patient's bodily self and functioning, too psychologically
repugnant to the patient, too suppressive of the patient's mental life, or
prohibitive in cost. Moral certainty of excessive burdensomeness is required
to justify withdrawal of artificial hydration and nutrition."
"There are certain particular cautions that should be taken in executing a
living will. First, the document should clearly distinguish between a
terminal condition in which death is imminent, and other conditions in which
one could live a long time with easily provided medical care. Second, one
should never ask for or demand euthanasia, mercy killing or the withholding
of "ordinary means" of sustaining life. This is not only wrong for the
signer of the document, but it also does a serious injustice to physicians,
family and medical personnel to whom such immoral demands are made. Third,
if there is any possibility that the signer may become pregnant, then
certainly every measure should be called for to preserve the life of the
unborn child."
"Whenever a person executes such a document, he or she has to confront the
realities of life and of death. It is a time when the family, especially a
spouse, should be consulted and decisions are best made together. A person's
physician and sometimes an attorney should be consulted. One need not shy
away from executing a living will . . ." |
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These documents may be reproduced without further permission and were made
available by:
Florida Catholic Conference
P. O. Box 1638
Tallahassee, FL 32302-1638
Tel.: (850) 222-3803
Fax: (850) 681-9548
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