Advance directives should meet legal requirements.

Advance directives should meet legal requirements, like the signature of witnesses and the patient’s competence. The document must also be kept in a secure location, which is accessible when needed. Members of families and health care surrogates must also be informed of the particulars of the directive so that they may be able to seek clarifications if needed.  The emergency room or intensive care unit is not the ideal place to start gathering and looking for advance directives.

It is important to update your advance directive

An advance directive has no expiration date attached to it unless otherwise changed by the principal. Nevertheless, it is important to keep the documents updated. It’s a good practice to review, re-sign and re-date them especially when there are changes in the principal’s health or circumstance. It may be a good practice to look over the advance directive regularly (perhaps, every year) even if everything is stable. Through this practice, physicians and family members can be assured that they are following the patient’s current wishes.

Advance directives can be changed.

Competent individuals can change their plans of care at any time.  Treatment decisions for incapacitated patients can be changed by their surrogates, “provided that the change is consistent with the patient’s explicit preferences, or in the absence of these, the patients’ inferred values and preferences; or, if these cannot be known, the patient’s best interest.”[1]

The declarations in advance directives are legally and morally recognized.  It is important to remember that consent of the person or the surrogate is required before medical treatments and procedures are carried out, “except in an emergency situation when consent cannot be obtained and there is no indication that the patient would refuse consent to the treatment.”[2]

Our faith is important to us.  We need to see to it that our advance directives are in line with the teachings of the Church.

It is crucial to be educated and be aware not only of the legal but also of the moral implications of the declarations in our advance directive. We must consider how our decisions affect our faith, our relationship with God and with our family in writing an advance directive.  As Pope Pius XII cited, we are only obliged to use ordinary or proportionate means to preserve life. All temporal activities including life and death are only subordinated to spiritual ends.  Our advance directives should show the values inculcated in our faith.[3]

We cannot just write anything we can think about in our advance directive. We consult with our family, surrogates, physicians, and a person who is knowledgeable about the teachings of the church on end-of-life issues, usually a member of the clergy. It is important to receive “all reasonable information about the essential nature of the proposed treatment and its benefits; its risk, side effects, consequences, and cost; and any reasonable and morally legitimate alternatives, including no treatment at all.”[4]

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[1] Nancy Berlinger, Bruce Jennings, Susan Wolf, The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life, revised and expanded second ed. (New York: Oxford University Press, 2013), 63.

[2] USCCB, “Ethical and Religious Directives,” No. 26.

[3] National Catholic Bioethics Center (NCBC), A Catholic Guide to End-of-Life Decisions: An Explanation of Church Teachings on Advance Directives, Euthanasia, and Physical –Assisted Suicide,  (Philadelphia, PA: NCBC, 2011).

[4]  USCCB, “Ethical and Religious Directives,” No. 27.